Epidemiology of injuries at the first Transplant Football World Cup

VALENTINA TOTTI^1*Filippo Ferrari²Simone Paltrinieri²Giovanni Vitale¹Giovanni Mosconi³Alessandro Nanni Costa³Gianluigi Sella³Maria Cristina Morelli¹Paolo Caraceni^1,2Giulio Sergio Roi²

• ¹IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico di Sant'Orsola, Bologna, Italy
• ²Universita degli Studi di Bologna Dipartimento di Scienze Mediche e Chirurgiche, Bologna, Italy
• ³Fondazione Policlinico Sant'Orsola, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico di Sant'Orsola, Bologna, Italy

Introduction: Recreational football is widely recognized as a health-promoting activity, with proven long-term benefits for physical and mental well-being. For transplant recipients, it offers additional value by supporting recovery, reintegration, and quality of life. To promote safe participation in sport among this population, the World Transplant Games Federation launched the 1st World Transplant Football Cup. This study aimed to investigate the epidemiology of injuries sustained during the tournament. Methods: Matches were conducted according to modified FIFA 7-a-side rules, tailored to ensure the safety of transplanted organs and tissues. Each team included up to 16 players of any age or gender. Matches lasted 20 minutes, with unlimited substitutions. Games were played on two standard 60 × 40 m pitches with 3 m goals. Medical coverage was ensured by two sports physicians present throughout the event. Injury data were collected using a standardized form for all requests for medical intervention (RfMI). Results: A total of 172 transplant recipients participated (kidney: n=103; liver: n=25; bone marrow: n=18; heart: n=14; kidney-pancreas: n=7; lung: n=5), representing 11 teams. Across 35 matches (total exposure: 326 hours and 40 minutes), 28 RfMIs were reported (16% of participants). Players (mean age 36.0 ± 11.1 years) included 26 males and 2 females, distributed across all field positions. Injury mechanisms were non-contact (43%), indirect contact (32%), and direct contact (25%). Most injuries were acute (82%), followed by acute-on-chronic (12%) and chronic (4%). The most frequent injury types were contusions (32%), sprains (21%), muscle strains (18%), and abrasions (14%), with less common events including tendinopathies, minor concussions, and toe infections (4%). The incidence of RfMI was 85.7 per 1,000 hours (95% CI: 54.0–117.4), and time-loss injuries (n=17) occurred at a rate of 52.0 per 1,000 hours (95% CI: 27.3–76.8). All injuries were managed on site, except one which required hospital care. Conclusions: Despite a moderate incidence of injury, the majority were minor and no transplant-related injuries were recorded. These findings support the safety and feasibility of recreational football in transplant recipients, reinforcing its role as a beneficial component of long-term health promotion.