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Original Research |

Evaluation of Pulmonary Function and Exercise Performance by Cardiopulmonary Exercise Testing Before and After Lung TransplantationExercise Testing and Lung Transplant

Matthew N. Bartels, MD, MPH; Hilary F. Armstrong, MA; Renee E. Gerardo, MA; Aimee M. Layton, MA; Benjamin O. Emmert-Aronson, MS; Joshua R Sonett, MD; Selim M Arcasoy, MD, FCCP
Author and Funding Information

From the Department of Rehabilitation and Regenerative Medicine, College of Physicians and Surgeons (Dr Bartels and Mss Armstrong and Gerardo), the Department of Surgery (Ms Layton and Dr Sonett), and the Department of Medicine (Dr Arcasoy), Columbia University New York, NY; and the Department of Psychology (Mr Emmert-Aronson), Boston University, Boston, MA.

Correspondence to: Matthew N. Bartels, MD, MPH, 630 W 168th St, HP 1-169b, New York, NY 10032; e-mail: mnb4@columbia.edu

Data are presented as mean (% predicted ± SD) unless otherwise indicated. CPET = cardiopulmonary exercise testing; Dlco = diffusing capacity of the lung for carbon monoxide; HR = heart rate; LTx = lung transplant; MVV = maximum voluntary ventilation; PFT = pulmonary function test; RER = respiratory exchange ratio; TLC = total lung capacity; V˙ co2 = volume of CO2; V˙ e/V˙ co2 = minute ventilation to volume of CO2 produced; V˙ o2 = volume of oxygen; VT = ventilatory threshold.

a

Based on 90 patients who had a TLC test.

b

Based on 82 patients who had a Dlco test.

c

Based on 37 subjects who had VT work measured before transplant. Other subjects were unable to reach VT before transplant.

Data are presented as mean (% predicted ± SD) unless otherwise indicated. See Table 1 legend for expansion of abbreviations.

Funding/Support: This study was funded by the VIDDA Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Funding/Support: This study was funded by the VIDDA Foundation.

Funding/Support: This study was funded by the VIDDA Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1604-1611. doi:10.1378/chest.10-2721
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Background:  Detailed description of functional exercise outcomes before and after lung transplantation is lacking. The objective of this study was to describe and compare posttransplant improvement in lung function and peak exercise parameters in patients with advanced lung disease.

Methods:  The study included 153 patients who underwent lung transplantation over 7 years who had complete cardiopulmonary exercise testing (CPET) and pulmonary function tests (PFTs) before and after lung transplantation. CPET and PFT within 30 months pretransplant and posttransplant were compared.

Results:  Pulmonary function markedly improved posttransplant as FVC increased 67%, maximum voluntary ventilation increased 91%, and FEV1 increased 136%. However, peak oxygen consumption increased only 19%, peak CO2 production increased 50%, and peak work increased 78%. Although transplant recipients had a 1.5- to 2.0-fold increase in exercise capacity posttransplant, peak exercise capacity remained at 50% of the predicted normal, suggesting a maximal limitation. Subgroup stratification into quartiles based on pretransplant exercise capacity revealed the greatest exercise benefit to be in the lowest functional pretransplant groups.

Conclusions:  Lung transplant recipients have an increase in exercise capacity that does not match the improvement in lung function, indicating that poor strength, deconditioning, or other peripheral factors play a significant role in the limitation of exercise benefit posttransplantation. Further elucidation of the mechanisms of exercise limitation may allow for improved exercise outcomes posttransplant.

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