Interpretation of the 2024 European position paper: rehabilitation management after heart transplantation_Chinese Journal of Evidence-Based Medicine

Authors：

ZHAO Shiguo ¹ , WANG Lei ² ,  LIU Xiwang ¹ , ZHANG Chenmei ¹

1. Children’s Hospital, Zhejiang University School of Medicine; National Clinical Research Center for Child Health, Hangzhou 310052, P. R. China;
2. Affiliated Zhejiang Hospital Zhejiang University School of Medicine, Hangzhou 310027, P. R. China;

Corresponding author：

LIU Xiwang, Email: liuxw@zju.edu.cn

Keywords：

Heart transplantation; Rehabilitation; Position paper; Guidelines; Expert consensus

DOI：

10.7507/1672-2531.202505139

Video：

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Abstract Full text Figures/Tables Video References Cited by

Heart transplantation is a key treatment option for patients with end-stage heart failure. However, post-transplant recipients often face complex rehabilitation challenges due to cardiac denervation, lifelong immunosuppressive therapy, and common complications such as hypertension, dyslipidemia, and post-transplant diabetes mellitus. This article aims to interpret the 2024 position paper jointly released by the European Society of Cardiology and the European Society for Organ Transplantation on post-transplant rehabilitation, and to systematically summarizes the core strategies proposed in rehabilitation management, including optimizing immunosuppressive therapy, individualized exercise prescriptions, lifestyle interventions, and psychosocial support

1.	Khush KK, Hsich E, Potena L, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation: thirty-eighth adult heart transplantation report - 2021; focus on recipient characteristics. J Heart Lung Transplant, 2021, 40(10): 1035-1049.
2.	Lund LH, Edwards LB, Kucheryavaya AY, et al. The registry of the international society for heart and lung transplantation: thirty-first official adult heart transplant report-2014; focus theme: retransplantation. J Heart Lung Transplant, 2014, 33(10): 996-1008.
3.	Agarwal A, Prasad GV. Post-transplant dyslipidemia: mechanisms, diagnosis and management. World J Transplant, 2016, 6(1): 125-134.
4.	Kim HJ, Jung SH, Kim JJ, et al. New-onset diabetes mellitus after heart transplantation - incidence, risk factors and impact on clinical outcome. Circ J, 2017, 81(6): 806-814.
5.	Sharif A, Hecking M, de Vries AP, et al. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions. Am J Transplant, 2014, 14(9): 1992-2000.
6.	Simonenko M, Hansen D, Niebauer J, et al. Prevention and rehabilitation after heart transplantation: a clinical consensus statement of the European association of preventive cardiology, heart failure association of the ESC, and the European cardio thoracic transplant association, a section of ESOT. Eur J Heart Fail, 2024, 26(9): 1876-1892.
7.	Cogswell R, John R, Estep JD, et al. An early investigation of outcomes with the new 2018 donor heart allocation system in the United States. J Heart Lung Transplant, 2020, 39(1): 1-4.
8.	Grupper A, Gewirtz H, Kushwaha S. Reinnervation post-heart transplantation. Eur Heart J, 2018, 39(20): 1799-1806.
9.	Myers J, Gullestad L, Bellin D, et al. Physical activity patterns and exercise performance in cardiac transplant recipients. J Cardiopulm Rehabil, 2003, 23(2): 100-106.
10.	Yardley M, Gullestad L, Bendz B, et al. Long-term effects of high-intensity interval training in heart transplant recipients: a 5-year follow-up study of a randomized controlled trial. Clin Transplant, 2017, 31(1): e12868.
11.	Masarone D, Melillo E, Petraio A, et al. Exercise-based rehabilitation strategies in heart transplant recipients: Focus on high-intensity interval training. Clin Transplant, 2021, 35(2): e14143.
12.	Thomson D, Maddison A, Sharp J. A cross-sectional study of return to work rate following heart transplantation and the contributing role of illness perceptions. J Cardiopulm Rehabil Prev, 2019, 39(4): 253-258.
13.	Stubber C, Kirkman M. The experiences of adult heart, lung, and heart-lung transplantation recipients: a systematic review of qualitative research evidence. PLoS One, 2020, 15(11): e0241570.
14.	Petrucci L, Ricotti S, Michelini I, et al. Return to work after thoracic organ transplantation in a clinically-stable population. Eur J Heart Fail, 2007, 9(11): 1112-1119.
15.	de la Rosa A, Singer-Englar T, Hamilton MA, et al. The impact of depression on heart transplant outcomes: a retrospective single-center cohort study. Clin Transplant, 2021, 35(3): e14204.
16.	Costello JP, Mohanakumar T, Nath DS. Mechanisms of chronic cardiac allograft rejection. Tex Heart Inst J, 2013, 40(4): 395-399.
17.	Lachance K, White M, de Denus S. Risk factors for chronic renal insufficiency following cardiac transplantation. Ann Transplant, 2015, 20: 576-587.
18.	Costel D, Ghiga D, Voidazan S, et al. Immunosuppressive medication and non-rejection-related complications following heart transplantation. J Interdiscip Med, 2020, 5: 76-80.
19.	Kelsh SE, Girgis R, Dickinson M, et al. Everolimus use for intolerance or failure of baseline immunosuppression in adult heart and lung transplantation. Ann Transplant, 2018, 23: 744-750.
20.	Velleca A, Shullo MA, Dhital K, et al. The international society for heart and lung transplantation (ISHLT) guidelines for the care of heart transplant recipients. J Heart Lung Transplant, 2023, 42(5): e1-e141.
21.	Farouk SS, Rein JL. The many faces of calcineurin inhibitor toxicity-what the FK. Adv Chronic Kidney Dis, 2020, 27(1): 56-66.
22.	Nygaard S, Christensen AH, Sletner L, et al. Predictors of hypertension development 1 year after heart transplantation. Transplantation, 2022, 106(8): 1656-1665.
23.	Mancia G, Kreutz R, Brunström M, et al. 2023 ESH guidelines for the management of arterial hypertension the task force for the management of arterial hypertension of the European society of hypertension: endorsed by the international society of hypertension (ISH) and the European renal association (ERA). J Hypertens, 2023, 41(12): 1874-2071.
24.	Lewis CE, Fine LJ, et al. Final report of a trial of intensive versus standard blood-pressure control. N Engl J Med, 2021, 384(20): 1921-1930.
25.	Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J, 2020, 41(1): 111-188.
26.	Golbus JR, Adie S, Yosef M, et al. Statin intensity and risk for cardiovascular events after heart transplantation. ESC Heart Fail, 2020, 7(5): 2074-2081.
27.	Sammour Y, Dezorzi C, Austin BA, et al. PCSK9 inhibitors in heart transplant patients: safety, efficacy, and angiographic correlates. J Card Fail, 2021, 27(7): 812-815.
28.	Alvarez-Alvarez RJ, Barge-Caballero E, Chavez-Leal SA, et al. Venous thromboembolism in heart transplant recipients: incidence, recurrence and predisposing factors. J Heart Lung Transplant, 2015, 34(2): 167-174.
29.	Witkowsky O, Teuteberg J, Althouse AD, et al. Thrombotic events with proliferation signal inhibitor‒based immunosuppression in cardiac transplantation. J Heart Lung Transplant, 2019, 38(6): 619-626.
30.	Thibodeau JT, Mishkin JD, Patel PC, et al. Sirolimus use and incidence of venous thromboembolism in cardiac transplant recipients. Clin Transplant, 2012, 26(6): 953-959.
31.	Roest S, Budde RPJ, Hesselink DA, et al. The prevalence of osteopenia and osteoporosis after heart transplantation assessed using CT. Clin Radiol, 2023, 78(10): 772-778.
32.	Caffarelli C, Tomai Pitinca MD, Alessandri M, et al. Timing of osteoporotic vertebral fractures in lung and heart transplantation: a longitudinal study. J Clin Med, 2020, 9(9): 2941.
33.	Adami G, Saag KG. Glucocorticoid-induced osteoporosis: 2019 concise clinical review. Osteoporos Int, 2019, 30(6): 1145-1156.
34.	Zhao J, Wang C, Hu Z. Efficacy and safety of bisphosphonates for osteoporosis or osteopenia in cardiac transplant patients: a meta-analysis. Transplant Proc, 2015, 47(10): 2957-2964.
35.	Ochiai N, Etani Y, Noguchi T, et al. The pivotal role of the Hes1/Piezo1 pathway in the pathophysiology of glucocorticoid-induced osteoporosis. JCI Insight, 2024, 9(23): e179963.
36.	Mizrahi N, Braun M, Ben Gal T, et al. Post-transplant diabetes mellitus: incidence, predicting factors and outcomes. Endocrine, 2020, 69(2): 303-309.
37.	Muir CA, Kuang W, Muthiah K, et al. Association of early post-transplant hyperglycaemia and diabetes mellitus on outcomes following heart transplantation. Diabet Med, 2025, 42(1): e15441.
38.	Sammour Y, Nassif M, Magwire M, et al. Effects of GLP-1 receptor agonists and SGLT-2 inhibitors in heart transplant patients with type 2 diabetes: initial report from a cardiometabolic center of excellence. J Heart Lung Transplant, 2021, 40(6): 426-429.
39.	Schumacher O, Trachsel LD, Herzig D, et al. Heart rate kinetics during standard cardiopulmonary exercise testing in heart transplant recipients: a longitudinal study. ESC Heart Fail, 2021, 8(2): 1096-1105.
40.	Dall CH, Snoer M, Christensen S, et al. Effect of high-intensity training versus moderate training on peak oxygen uptake and chronotropic response in heart transplant recipients: a randomized crossover trial. Am J Transplant, 2014, 14(10): 2391-2399.
41.	Kourek C, Karatzanos E, Nanas S, et al. Exercise training in heart transplantation. World J Transplant, 2021, 11(11): 466-479.
42.	Joglar JA, Wan EY, Chung MK, et al. Management of arrhythmias after heart transplant: current state and considerations for future research. Circ Arrhythm Electrophysiol, 2021, 14(3): e007954.
43.	Nytrøen K, Rolid K, Andreassen AK, et al. Effect of high-intensity interval training in de novo heart transplant recipients in Scandinavia. Circulation, 2019, 139(19): 2198-2211.
44.	Khush KK, Cherikh WS, Chambers DC, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation: thirty-sixth adult heart transplantation report - 2019; focus theme: donor and recipient size match. J Heart Lung Transplant, 2019, 38(10): 1056-1066.
45.	Asleh R, Briasoulis A, Kremers WK, et al. Long-term sirolimus for primary immunosuppression in heart transplant recipients. J Am Coll Cardiol, 2018, 71(6): 636-650.
46.	Zeltzer SM, Taylor DO, Tang WH. Long-term dietary habits and interventions in solid-organ transplantation. J Heart Lung Transplant, 2015, 34(11): 1357-1365.
47.	Tucker WJ, Beaudry RI, Samuel TJ, et al. Performance limitations in heart transplant recipients. Exerc Sport Sci Rev, 2018, 46(3): 144-151.
48.	Ambrosetti M, Abreu A, Corrà U, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: from knowledge to implementation. 2020 update. A position paper from the secondary prevention and rehabilitation section of the European association of preventive cardiology. Eur J Prev Cardiol, 2021, 28(5): 460-495.
49.	Bachmann JM, Shah AS, Duncan MS, et al. Cardiac rehabilitation and readmissions after heart transplantation. J Heart Lung Transplant, 2018, 37(4): 467-476.
50.	Uithoven KE, Smith JR, Medina-Inojosa JR, et al. Clinical and rehabilitative predictors of peak oxygen uptake following cardiac transplantation. J Clin Med, 2019, 8(1): 119.
51.	Hansen D, Abreu A, Ambrosetti M, et al. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the secondary prevention and rehabilitation section of the European association of preventive cardiology. Eur J Prev Cardiol, 2022, 29(1): 230-245.
52.	Iglesias D, Masson W, Barbagelata L, et al. Prognostic value of cardiopulmonary exercise test after heart transplantation. Clin Transplant, 2021, 35(8): e14387.
53.	Pascoalino LN, Ciolac EG, Tavares AC, et al. Exercise training improves ambulatory blood pressure but not arterial stiffness in heart transplant recipients. J Heart Lung Transplant, 2015, 34(5): 693-700.
54.	Rolid K, Andreassen AK, Yardley M, et al. High-intensity interval training and health-related quality of life in de novo heart transplant recipients - results from a randomized controlled trial. Health Qual Life Outcomes, 2020, 18(1): 283.
55.	Ciolac EG, Castro RE, Marçal IR, et al. Cardiac reinnervation affects cardiorespiratory adaptations to exercise training in individuals with heart transplantation. Eur J Prev Cardiol, 2020, 27(11): 1151-1161.
56.	Li C, Xu J, Qin W, et al. Meta-analysis of the effects of exercise training on markers of metabolic syndrome in solid organ transplant recipients. Prog Transplant, 2018, 28(3): 278-287.
57.	Awad M, Czer LS, Hou M, et al. Early denervation and later reinnervation of the heart following cardiac transplantation: a review. J Am Heart Assoc, 2016, 5(11): e004070.
58.	Sommer W, Knöfel AK, Izykowski N, et al. Physical exercise reduces transplant arteriosclerosis in a mouse aorta transplantation model. J Thorac Cardiovasc Surg, 2015, 149(1): 330-337.
59.	Nytrøen K, Rustad LA, Erikstad I, et al. Effect of high-intensity interval training on progression of cardiac allograft vasculopathy. J Heart Lung Transplant, 2013, 32(11): 1073-1080.
60.	郑哲. 中国心脏移植规范化高质量发展的探索与展望. 中国循环杂志, 2025, 40(4): 313-314.

1. Khush KK, Hsich E, Potena L, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation: thirty-eighth adult heart transplantation report - 2021; focus on recipient characteristics. J Heart Lung Transplant, 2021, 40(10): 1035-1049.
2. Lund LH, Edwards LB, Kucheryavaya AY, et al. The registry of the international society for heart and lung transplantation: thirty-first official adult heart transplant report-2014; focus theme: retransplantation. J Heart Lung Transplant, 2014, 33(10): 996-1008.
3. Agarwal A, Prasad GV. Post-transplant dyslipidemia: mechanisms, diagnosis and management. World J Transplant, 2016, 6(1): 125-134.
4. Kim HJ, Jung SH, Kim JJ, et al. New-onset diabetes mellitus after heart transplantation - incidence, risk factors and impact on clinical outcome. Circ J, 2017, 81(6): 806-814.
5. Sharif A, Hecking M, de Vries AP, et al. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions. Am J Transplant, 2014, 14(9): 1992-2000.
6. Simonenko M, Hansen D, Niebauer J, et al. Prevention and rehabilitation after heart transplantation: a clinical consensus statement of the European association of preventive cardiology, heart failure association of the ESC, and the European cardio thoracic transplant association, a section of ESOT. Eur J Heart Fail, 2024, 26(9): 1876-1892.
7. Cogswell R, John R, Estep JD, et al. An early investigation of outcomes with the new 2018 donor heart allocation system in the United States. J Heart Lung Transplant, 2020, 39(1): 1-4.
8. Grupper A, Gewirtz H, Kushwaha S. Reinnervation post-heart transplantation. Eur Heart J, 2018, 39(20): 1799-1806.
9. Myers J, Gullestad L, Bellin D, et al. Physical activity patterns and exercise performance in cardiac transplant recipients. J Cardiopulm Rehabil, 2003, 23(2): 100-106.
10. Yardley M, Gullestad L, Bendz B, et al. Long-term effects of high-intensity interval training in heart transplant recipients: a 5-year follow-up study of a randomized controlled trial. Clin Transplant, 2017, 31(1): e12868.
11. Masarone D, Melillo E, Petraio A, et al. Exercise-based rehabilitation strategies in heart transplant recipients: Focus on high-intensity interval training. Clin Transplant, 2021, 35(2): e14143.
12. Thomson D, Maddison A, Sharp J. A cross-sectional study of return to work rate following heart transplantation and the contributing role of illness perceptions. J Cardiopulm Rehabil Prev, 2019, 39(4): 253-258.
13. Stubber C, Kirkman M. The experiences of adult heart, lung, and heart-lung transplantation recipients: a systematic review of qualitative research evidence. PLoS One, 2020, 15(11): e0241570.
14. Petrucci L, Ricotti S, Michelini I, et al. Return to work after thoracic organ transplantation in a clinically-stable population. Eur J Heart Fail, 2007, 9(11): 1112-1119.
15. de la Rosa A, Singer-Englar T, Hamilton MA, et al. The impact of depression on heart transplant outcomes: a retrospective single-center cohort study. Clin Transplant, 2021, 35(3): e14204.
16. Costello JP, Mohanakumar T, Nath DS. Mechanisms of chronic cardiac allograft rejection. Tex Heart Inst J, 2013, 40(4): 395-399.
17. Lachance K, White M, de Denus S. Risk factors for chronic renal insufficiency following cardiac transplantation. Ann Transplant, 2015, 20: 576-587.
18. Costel D, Ghiga D, Voidazan S, et al. Immunosuppressive medication and non-rejection-related complications following heart transplantation. J Interdiscip Med, 2020, 5: 76-80.
19. Kelsh SE, Girgis R, Dickinson M, et al. Everolimus use for intolerance or failure of baseline immunosuppression in adult heart and lung transplantation. Ann Transplant, 2018, 23: 744-750.
20. Velleca A, Shullo MA, Dhital K, et al. The international society for heart and lung transplantation (ISHLT) guidelines for the care of heart transplant recipients. J Heart Lung Transplant, 2023, 42(5): e1-e141.
21. Farouk SS, Rein JL. The many faces of calcineurin inhibitor toxicity-what the FK. Adv Chronic Kidney Dis, 2020, 27(1): 56-66.
22. Nygaard S, Christensen AH, Sletner L, et al. Predictors of hypertension development 1 year after heart transplantation. Transplantation, 2022, 106(8): 1656-1665.
23. Mancia G, Kreutz R, Brunström M, et al. 2023 ESH guidelines for the management of arterial hypertension the task force for the management of arterial hypertension of the European society of hypertension: endorsed by the international society of hypertension (ISH) and the European renal association (ERA). J Hypertens, 2023, 41(12): 1874-2071.
24. Lewis CE, Fine LJ, et al. Final report of a trial of intensive versus standard blood-pressure control. N Engl J Med, 2021, 384(20): 1921-1930.
25. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J, 2020, 41(1): 111-188.
26. Golbus JR, Adie S, Yosef M, et al. Statin intensity and risk for cardiovascular events after heart transplantation. ESC Heart Fail, 2020, 7(5): 2074-2081.
27. Sammour Y, Dezorzi C, Austin BA, et al. PCSK9 inhibitors in heart transplant patients: safety, efficacy, and angiographic correlates. J Card Fail, 2021, 27(7): 812-815.
28. Alvarez-Alvarez RJ, Barge-Caballero E, Chavez-Leal SA, et al. Venous thromboembolism in heart transplant recipients: incidence, recurrence and predisposing factors. J Heart Lung Transplant, 2015, 34(2): 167-174.
29. Witkowsky O, Teuteberg J, Althouse AD, et al. Thrombotic events with proliferation signal inhibitor‒based immunosuppression in cardiac transplantation. J Heart Lung Transplant, 2019, 38(6): 619-626.
30. Thibodeau JT, Mishkin JD, Patel PC, et al. Sirolimus use and incidence of venous thromboembolism in cardiac transplant recipients. Clin Transplant, 2012, 26(6): 953-959.
31. Roest S, Budde RPJ, Hesselink DA, et al. The prevalence of osteopenia and osteoporosis after heart transplantation assessed using CT. Clin Radiol, 2023, 78(10): 772-778.
32. Caffarelli C, Tomai Pitinca MD, Alessandri M, et al. Timing of osteoporotic vertebral fractures in lung and heart transplantation: a longitudinal study. J Clin Med, 2020, 9(9): 2941.
33. Adami G, Saag KG. Glucocorticoid-induced osteoporosis: 2019 concise clinical review. Osteoporos Int, 2019, 30(6): 1145-1156.
34. Zhao J, Wang C, Hu Z. Efficacy and safety of bisphosphonates for osteoporosis or osteopenia in cardiac transplant patients: a meta-analysis. Transplant Proc, 2015, 47(10): 2957-2964.
35. Ochiai N, Etani Y, Noguchi T, et al. The pivotal role of the Hes1/Piezo1 pathway in the pathophysiology of glucocorticoid-induced osteoporosis. JCI Insight, 2024, 9(23): e179963.
36. Mizrahi N, Braun M, Ben Gal T, et al. Post-transplant diabetes mellitus: incidence, predicting factors and outcomes. Endocrine, 2020, 69(2): 303-309.
37. Muir CA, Kuang W, Muthiah K, et al. Association of early post-transplant hyperglycaemia and diabetes mellitus on outcomes following heart transplantation. Diabet Med, 2025, 42(1): e15441.
38. Sammour Y, Nassif M, Magwire M, et al. Effects of GLP-1 receptor agonists and SGLT-2 inhibitors in heart transplant patients with type 2 diabetes: initial report from a cardiometabolic center of excellence. J Heart Lung Transplant, 2021, 40(6): 426-429.
39. Schumacher O, Trachsel LD, Herzig D, et al. Heart rate kinetics during standard cardiopulmonary exercise testing in heart transplant recipients: a longitudinal study. ESC Heart Fail, 2021, 8(2): 1096-1105.
40. Dall CH, Snoer M, Christensen S, et al. Effect of high-intensity training versus moderate training on peak oxygen uptake and chronotropic response in heart transplant recipients: a randomized crossover trial. Am J Transplant, 2014, 14(10): 2391-2399.
41. Kourek C, Karatzanos E, Nanas S, et al. Exercise training in heart transplantation. World J Transplant, 2021, 11(11): 466-479.
42. Joglar JA, Wan EY, Chung MK, et al. Management of arrhythmias after heart transplant: current state and considerations for future research. Circ Arrhythm Electrophysiol, 2021, 14(3): e007954.
43. Nytrøen K, Rolid K, Andreassen AK, et al. Effect of high-intensity interval training in de novo heart transplant recipients in Scandinavia. Circulation, 2019, 139(19): 2198-2211.
44. Khush KK, Cherikh WS, Chambers DC, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation: thirty-sixth adult heart transplantation report - 2019; focus theme: donor and recipient size match. J Heart Lung Transplant, 2019, 38(10): 1056-1066.
45. Asleh R, Briasoulis A, Kremers WK, et al. Long-term sirolimus for primary immunosuppression in heart transplant recipients. J Am Coll Cardiol, 2018, 71(6): 636-650.
46. Zeltzer SM, Taylor DO, Tang WH. Long-term dietary habits and interventions in solid-organ transplantation. J Heart Lung Transplant, 2015, 34(11): 1357-1365.
47. Tucker WJ, Beaudry RI, Samuel TJ, et al. Performance limitations in heart transplant recipients. Exerc Sport Sci Rev, 2018, 46(3): 144-151.
48. Ambrosetti M, Abreu A, Corrà U, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: from knowledge to implementation. 2020 update. A position paper from the secondary prevention and rehabilitation section of the European association of preventive cardiology. Eur J Prev Cardiol, 2021, 28(5): 460-495.
49. Bachmann JM, Shah AS, Duncan MS, et al. Cardiac rehabilitation and readmissions after heart transplantation. J Heart Lung Transplant, 2018, 37(4): 467-476.
50. Uithoven KE, Smith JR, Medina-Inojosa JR, et al. Clinical and rehabilitative predictors of peak oxygen uptake following cardiac transplantation. J Clin Med, 2019, 8(1): 119.
51. Hansen D, Abreu A, Ambrosetti M, et al. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the secondary prevention and rehabilitation section of the European association of preventive cardiology. Eur J Prev Cardiol, 2022, 29(1): 230-245.
52. Iglesias D, Masson W, Barbagelata L, et al. Prognostic value of cardiopulmonary exercise test after heart transplantation. Clin Transplant, 2021, 35(8): e14387.
53. Pascoalino LN, Ciolac EG, Tavares AC, et al. Exercise training improves ambulatory blood pressure but not arterial stiffness in heart transplant recipients. J Heart Lung Transplant, 2015, 34(5): 693-700.
54. Rolid K, Andreassen AK, Yardley M, et al. High-intensity interval training and health-related quality of life in de novo heart transplant recipients - results from a randomized controlled trial. Health Qual Life Outcomes, 2020, 18(1): 283.
55. Ciolac EG, Castro RE, Marçal IR, et al. Cardiac reinnervation affects cardiorespiratory adaptations to exercise training in individuals with heart transplantation. Eur J Prev Cardiol, 2020, 27(11): 1151-1161.
56. Li C, Xu J, Qin W, et al. Meta-analysis of the effects of exercise training on markers of metabolic syndrome in solid organ transplant recipients. Prog Transplant, 2018, 28(3): 278-287.
57. Awad M, Czer LS, Hou M, et al. Early denervation and later reinnervation of the heart following cardiac transplantation: a review. J Am Heart Assoc, 2016, 5(11): e004070.
58. Sommer W, Knöfel AK, Izykowski N, et al. Physical exercise reduces transplant arteriosclerosis in a mouse aorta transplantation model. J Thorac Cardiovasc Surg, 2015, 149(1): 330-337.
59. Nytrøen K, Rustad LA, Erikstad I, et al. Effect of high-intensity interval training on progression of cardiac allograft vasculopathy. J Heart Lung Transplant, 2013, 32(11): 1073-1080.
60. 郑哲. 中国心脏移植规范化高质量发展的探索与展望. 中国循环杂志, 2025, 40(4): 313-314.

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Latest ArticlesInterpretation of the 2024 European position paper: rehabilitation management after heart transplantation

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