Healthy Aging After an Organ Transplant

A special thanks for writing this blog goes to:

Dr. Kymberly Watt, Transplant Hepatologist, Mayo Clinic Minnesota.

Dr. Maryam Sadat Aleali, General Practitioner and Gastroenterology Research Fellow. 

If you are frequent readers of the blog, you know that we often write about topics that are important to our discussion group members. As our members get further out from their transplants, they are interested in discussing healthy aging and what that looks like for a post-transplant patient.

Our amazing mentor and group member @rosemarya, says “A healthy lifestyle has been a primary focus ever since I was diagnosed with a liver disease that resulted in an organ transplant. I am 16 years post liver and kidney transplant and my life with my organ transplant has been rewarding. I am getting older, and I want to learn all I can about how to continue a healthy lifestyle for me and my transplanted organs. I want to celebrate more birthdays!”

Don’t we all want more birthdays, more days with family and friends, and more rewarding experiences?

We are currently witnessing a rapid increase in the population of people over 65 years old in comparison to other age groups around the globe. There has been a notable increase in the number of liver transplant recipients older than 65 years of age due to increased access to transplant for older individuals, the improved survival of the transplanted organ (graft) and patient and improved overall healthcare. Thus, it is important now more than ever to increase awareness about healthy aging to improve the quality of life in this age group, particularly transplant recipients.

In general, keys to healthy aging are determined by multiple factors including diet and physical activity, along with mental and social health. Maintaining healthy aging among transplant recipients has additional challenges including minimizing downstream effects of chronic immunosuppression on health.

Cancer and infection  

Receiving immunosuppressive medication for reducing the risk of organ rejection puts patients at a higher risk of infection, different types of malignancies, and can contribute to chronic injury of other organs.

The elderly may be more likely to face the complications of immunosuppressive medications. There is a gradual decline in immune function as a person ages. Thus, the risk of rejection decreases in the older population of transplant recipients. The body's ability to clear drugs also declines with age, thus medical care providers may have more leeway to reduce and modify the immunosuppressive medication based on each patient's medical conditions and health concerns to minimize any unwanted adverse effects.

Infections have a more deleterious effect on older individuals. To avoid or minimize the effects of infection, vaccination for common viral and bacterial infections is strongly recommended. Prompt identification and early treatment of infections are advised. Transplant recipients are educated on signs and symptoms of infection to seek timely medical attention.

Cancer prevention strategies include education on cancer risks and individualized risk minimization efforts such as sun protection, exercise and weight management and medication optimization. Routine cancer screening can ensure the early detection of cancer emergence in this population.

Chronic disorders and metabolic concerns 

Obesity, high blood pressure, high lipid levels, and other risk factors for heart disease increase with aging. These same metabolic concerns also increase after transplant due to immunosuppression medications and weight gain that continues unchecked. A healthy diet and regular physical activity play an important role in preventing and minimizing these complications in aging transplant recipients. Avoiding excess weight gain after transplant in most  transplant recipients is crucial. Once identified, aggressive management of these medical complications is advised to reduce the impact on heart disease, chronic kidney disease and cancers.

Transplant recipients are at a higher risk of chronic kidney disease that can be the result of aging itself, pre-transplant kidney disease, the effects of these metabolic complication (above) and direct injury from certain immunosuppressive medications.

In addition, weight gain and these metabolic complications increase fatty liver disease, including in a transplanted liver. Fatty liver disease is a condition that can lead to chronic liver disease if not managed.

Bone loss

Another challenging condition among older transplant recipients is bone loss called osteoporosis. This increases the risk of broken bones which can have dramatic impact on quality and quantity of life. Proper vitamin D and calcium supplementation in addition to weight-bearing exercise can help prevent this condition and therefore bone fractures in this population. Once identified, additional treatment with medication to improve density is often needed.

Hormonal changes and sexual function

Sexual health can be affected by age alone, by any chronic disease and many other factors including mental & social health, body image, etc. This does not automatically improve after transplant. Immunosuppressive drugs and other medications among transplant recipients can also negatively affect sexual function in addition to the negative effects of all the metabolic complications discussed previously that also impact sexual health.  Immunosuppressive drugs are not a contraindication to receiving hormonal therapy, but discussion with the transplant team is recommended as hormonal therapy may have other concerns relative to the transplant organ. Managing sexual dysfunction can be multifaceted and successful so you should definitely consider discussing this with your care team.

Mental and cognitive health

For some, life after transplantation can be emotionally draining and anxiety-inducing due to the concerns over life-long medical care requirements and health scares. This is in addition to a higher risk of cognitive decline witnessed among some solid organ transplant recipients, particularly the older population. Identifying anxiety and depression as well as cognitive decline is the first step. Maintaining social activities along with seeking help from mental health professionals and medical care providers in addressing these conditions can help improve the quality of life in this population.

We know this is a lot of information to take in. It’s good to remember that this information may not apply to all patients. Some may have one or two of these issues and some may have none. But as we’ve said in the past, knowledge is power, and it’s a great idea to keep this information in mind for when you may need it.

While this information was written by liver specialists, it can apply to any organ transplant patient. Talk to your doctor about concerns with any of these challenges.

What have been your struggles as you age after transplant? How did you address them?

HELPFUL LINKS

• Read our Top Transplant Tips and Hacks
• Learn more about our discussion group at Mayo Clinic Connect
• Explore Mayo’s Transplant Center.
• Request an appointment.