FIG 67.27 Kaplan-Meier survival curves for primary and repeat transplants (From the registry of the International Society of Heart and Lung Transplantation J Heart Lung Transplant 2016;35(10):1185–1195.) FIG 67.28 Kaplan-Meier survival for retransplantation in children by intertransplant interval (From the registry of the International Society of Heart and Lung Transplantation J Heart Lung Transplant 2016;35(10):1185–1195.) FIG 67.29 Kaplan-Meier survival for retransplantation in children by reason for retransplantation (From the registry of the International Society of Heart and Lung Transplantation J Heart Lung Transplant 2016;35(10):1185–1195.) Exercise and Aerobic Capacity Exercise restriction is not usually necessary after transplantation, and children should be encouraged to participate in all age-appropriate sporting activities Children can generally return to routine exercise once their incisions have healed Following transplantation, physiologic responses to exercise may be impaired, although published data are limited Exercise impairment is related to several factors, including age at transplantation,87,88 deconditioning prior to transplantation, degree of reinnervation,89,90 chronotropic incompetence,88,91,92 comorbidities such as renal dysfunction, respiratory abnormalities, as well as the effects of medication such as corticosteroids and calcineurin inhibitors on skeletal muscle function In general, studies examining exercise performance in children have demonstrated a blunted response of heart rate to graded exercise88,93 and decreased maximal consumption of oxygen,88,91,93,94 although