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Mora-Cuesta VM, Martínez-Meñaca A, González-Fernández Á, Iturbe-Fernández D, Tello-Mena S, Izquierdo-Cuervo S, Fernández-Rozas S, Alonso-Lecue P, Cifrián-Martínez JM. The impact of time from ILD diagnosis to referral to the transplant center on the probability of inclusion in the transplant waiting list. Heart Lung 2024; 67:92-99. [PMID: 38735159 DOI: 10.1016/j.hrtlng.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Lung transplant is a therapeutic option for patients with progressive interstitial lung disease (ILD). OBJECTIVES The objective of this study was to determine whether time from ILD diagnosis to referral to a transplant center influences the probability of being included in the transplant waiting list. METHODS We performed a retrospective cohort study including all ILD patients evaluated as lung transplantation (LT) candidates at a lung transplant center between 01/01/2017 and 31/12/2022. The primary endpoint was the probability of being included in the lung transplant waiting list according to the time elapsed from diagnosis to referral to the transplant center. RESULTS A total of 843 lung transplant requests were received, of which 367 (43.5%) were associated with ILD. Thirteen patients were excluded because they did not attend the first visit, whereas another 11 were excluded because some information was missing. As a result, our final sample was composed of 343 patients. The median time from diagnosis to referral was 29.4 (10.9 - 61.1) months. The overall probability of inclusion in the waiting list was 29.7%. By time from diagnosis to referral, the probability of inclusion in the waiting list was 48.1% for the patients referred 〈 6 months from diagnosis; 27.5% for patients referred 6 to 24 months from diagnosis; and 25.8% for patients referred 〉 24 months from diagnosis (p = 0.007). CONCLUSIONS Early referral to a lung transplant center seemed to increase the probability of being included in the lung transplant waiting list. Further research is needed in this topic.
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Affiliation(s)
- Víctor M Mora-Cuesta
- Respiratory Department, Lung Transplant Unit, ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Marqués de Valdecilla University Hospital, Avda. Valdecilla s/n. 39008, Santander, Spain.
| | - Amaya Martínez-Meñaca
- Respiratory Department. ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Marqués de Valdecilla University Hospital, Spain
| | | | - David Iturbe-Fernández
- Respiratory Department, Lung Transplant Unit, ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Marqués de Valdecilla University Hospital, Avda. Valdecilla s/n. 39008, Santander, Spain
| | - Sandra Tello-Mena
- Respiratory Department, Lung Transplant Unit, ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Marqués de Valdecilla University Hospital, Avda. Valdecilla s/n. 39008, Santander, Spain
| | - Sheila Izquierdo-Cuervo
- Respiratory Department, Lung Transplant Unit, ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Marqués de Valdecilla University Hospital, Avda. Valdecilla s/n. 39008, Santander, Spain
| | - Sonia Fernández-Rozas
- Respiratory Department. ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Marqués de Valdecilla University Hospital, Spain
| | | | - José M Cifrián-Martínez
- Respiratory Department, Lung Transplant Unit, ERN-LUNG (European Reference Network on Rare Respiratory Diseases), Marqués de Valdecilla University Hospital, Avda. Valdecilla s/n. 39008, Santander, Spain
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van der Molen MC, Posthuma R, Hartman JE, van der Vaart H, Bij de Vaate E, Vaes AW, van den Borst B, van Ranst D, Spruit MA, Vanfleteren LEGW, Slebos DJ. Impact and timing of pulmonary rehabilitation in patients undergoing bronchoscopic lung volume reduction with endobronchial valves: A multicentre randomized controlled trial in patients with severe emphysema. Respirology 2024; 29:694-703. [PMID: 38720189 DOI: 10.1111/resp.14734] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/24/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND AND OBJECTIVE Both bronchoscopic lung volume reduction with endobronchial valves (BLVR-EBV) and pulmonary rehabilitation (PR) are effective treatments for improving exercise capacity and patient-reported outcomes in patients with severe Chronic Obstructive Pulmonary Disease (COPD). According to current recommendations, all BLVR-EBV patients should have undergone PR first. Our aim was to study the effects of PR both before and after BLVR-EBV compared to BLVR-EBV alone. METHODS We included patients with severe COPD who were eligible for BLVR-EBV and PR. Participants were randomized into three groups: PR before BLVR-EBV, PR after BLVR-EBV or BLVR-EBV without PR. The primary outcome was change in constant work rate cycle test (CWRT) endurance time at 6-month follow-up of the PR groups compared to BLVR-EBV alone. Secondary endpoints included changes in 6-minute walking test, daily step count, dyspnoea and health-related quality of life. RESULTS Ninety-seven participants were included. At 6-month follow-up, there was no difference in change in CWRT endurance time between the PR before BLVR-EBV and BLVR-EBV alone groups (median: 421 [IQR: 44; 1304] vs. 787 [123; 1024] seconds, p = 0.82) or in any of the secondary endpoints, but the PR after BLVR-EBV group exhibited a smaller improvement in CWRT endurance time (median: 107 [IQR: 2; 573], p = 0.04) and health-related quality of life compared to BLVR-EBV alone. CONCLUSION The addition of PR to BLVR-EBV did not result in increased exercise capacity, daily step count or improved patient-reported outcomes compared to BLVR-EBV alone, neither when PR was administered before BLVR-EBV nor when PR was administered after BLVR-EBV.
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Affiliation(s)
- Marieke C van der Molen
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rein Posthuma
- Department of Respiratory Medicine, Maastricht University, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Research and Development, Ciro, Horn, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Jorine E Hartman
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hester van der Vaart
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Center of Rehabilitation Beatrixoord, Haren, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Anouk W Vaes
- Department of Research and Development, Ciro, Horn, the Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dirk van Ranst
- Pulmonary Rehabilitation Center Revant, Breda, the Netherlands
| | - Martijn A Spruit
- Department of Respiratory Medicine, Maastricht University, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Research and Development, Ciro, Horn, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Lowie E G W Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Davalos-Yerovi V, Gómez-Garrido A, Garcia-Gutiérrez R, Berastegui C, Pujol-Blaya V, Launois P, Tejero-Sánchez M, Canut B, Curbelo YG, Sánchez-Rodríguez D. [Outcomes of respiratory rehabilitation program in lung transplant recipients: a quasi experimental study]. Rehabilitacion (Madr) 2024; 58:100862. [PMID: 38986344 DOI: 10.1016/j.rh.2024.100862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/03/2024] [Accepted: 06/13/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Lung transplant (LT) is the ultimate option for end-stage lung diseases. Malnutrition and sarcopenia, common in LT recipients, can be reversible with adequate exercise and nutrition. This study aims to assess changes in physical performance and aerobic capacity after a 10-week rehabilitation program (RP) in LT recipients, as well as to describe the prevalence of sarcopenia and malnutrition before and after RP and their influence on clinically relevant outcomes. MATERIALS AND METHODS Quasi-experimental study, before and after a 10-week PR in first-time TP recipients, aged over 18 years, from January 2022 to September 2023. Aerobic exercise capacity was assessed through the 6-minute walking test (6MWT) and peak oxygen consumption (VO2peak); and physical performance was measured using the Short Physical Performance Battery (SPPB). Additionally, the prevalence of sarcopenia was described according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2) and malnutrition according to the criteria of the Global Leadership Initiative on Malnutrition (GLIM). RESULTS Of the 41 patients, 56% had sarcopenia and 80% had malnutrition. After RP, the distance walked in the 6MWT increased by 66.3m (p=0.004) in men and 61m (p=0.001) in women. VO2peak increased in men by a mean of 3.1ml/min/kg (p=0.024). Physical performance improved significantly in both men and women according to the Short Physical Performance Battery (SPPB), with clinically relevant differences of 1.6 pts (p<0.001) and 1.2 pts (p=0.012), respectively. The prevalence of sarcopenia decreased to 24% and malnutrition to 61%. CONCLUSIONS RP proved to be an effective and safe intervention for LT recipients. In addition to improvements in skeletal muscle strength and exercise capacity, a reduction in the prevalence of sarcopenia and malnutrition was also observed.
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Affiliation(s)
- V Davalos-Yerovi
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Barcelona, España; Departamento de Medicina Física y Rehabilitación, Hospital Vall d'Hebron, Barcelona, España; Programa de Doctorado en Biomedicina, Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra - Escuela de Doctorado, Barcelona, España.
| | - A Gómez-Garrido
- Departamento de Medicina Física y Rehabilitación, Hospital Vall d'Hebron, Barcelona, España; Facultad de Medicina, Universitat Autònoma de Barcelona, España
| | - R Garcia-Gutiérrez
- Departamento de Medicina Física y Rehabilitación, Hospital Vall d'Hebron, Barcelona, España
| | - C Berastegui
- Programa de Trasplante Pulmonar, Departamento de Neumología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - V Pujol-Blaya
- Departamento de Medicina Física y Rehabilitación, Hospital Vall d'Hebron, Barcelona, España
| | - P Launois
- Departamento de Medicina Física y Rehabilitación, Hospital Vall d'Hebron, Barcelona, España; Facultad de Medicina, Universitat Autònoma de Barcelona, España
| | - M Tejero-Sánchez
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Barcelona, España; Departamento de Medicina Física y Rehabilitación, Hospital del Mar, Barcelona, España
| | - B Canut
- Departamento de Medicina Física y Rehabilitación, Hospital Vall d'Hebron, Barcelona, España
| | - Y G Curbelo
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Barcelona, España; Departamento de Medicina Física y Rehabilitación, Hospital del Mar, Barcelona, España
| | - D Sánchez-Rodríguez
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Bruselas, Bélgica
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Park JH, Shim JK, Choi M, Zhang HS, Jun NH, Choi S, Kwak YL. Influence of acute kidney injury and its recovery subtypes on patient-centered outcomes after lung transplantation. Sci Rep 2024; 14:10480. [PMID: 38714806 PMCID: PMC11076280 DOI: 10.1038/s41598-024-61352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/05/2024] [Indexed: 05/10/2024] Open
Abstract
This study aimed to investigate the association between acute kidney injury (AKI) recovery subtypes and days alive out of hospital within the first 3 months (DAOH-90) in patients undergoing lung transplantation. Patients who underwent lung transplantation from January 2012 to December 2021 were retrospectively analyzed and stratified into three groups: no-AKI, early recovery AKI (within 7 days), and non-early recovery AKI group. AKI occurred in 86 (35%) of patients, of which 40 (16%) achieved early recovery, and the remaining 46 (19%) did not. The median DAOH-90 was 21 days shorter in the AKI than in the no-AKI (P = 0.002), and 29 days shorter in the non-early recovery AKI group than in the no-AKI group (P < 0.001). Non-early recovery AKI and preoperative tracheostomy status were independently associated with shorter DAOH-90. The prevalence of CKD (76%), and 1-year mortality (48%) were highest in the non-early recovery AKI group. Postoperative AKI was associated with an adverse patient-centered quality measure for perioperative care, and shorter DAOH-90. The non-early recovery AKI group exhibited the worst prognosis in terms of DAOH-90, CKD progression, and 1-year mortality, highlighting the important role of AKI and early-recovery AKI on both the quality of life and clinical outcomes after lung transplantation.
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Affiliation(s)
- Jin Ha Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Mingee Choi
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Soo Zhang
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Na Hyung Jun
- Departments of Anesthesiology and Pain Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Seokyeong Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young-Lan Kwak
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Polastri M, Reed RM. Rehabilitative goals for patients undergoing lung retransplantation. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2024; 41:134-138. [PMID: 38576338 DOI: 10.12701/jyms.2024.00241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
Lung retransplantation (LRT) involves a second or subsequent lung transplant (LT) in a patient whose first transplanted graft has failed. LRT is the only treatment option for irreversible lung allograft failure caused by acute graft failure, chronic lung allograft dysfunction, or postoperative complications of bronchial anastomosis. Prehabilitation (rehabilitation before LT), while patients are on the waiting list, is recognized as an essential component of the therapeutic regimen and should be offered throughout the waiting period from the moment of listing until transplantation. LRT is particularly fraught with challenges, and prehabilitation to reduce frailty is one of the few opportunities to address modifiable risk factors (such as functional and motor impairments) in a patient population in which there is clearly room to improve outcomes. Although rehabilitative outcomes and quality of life in patients receiving or awaiting LT have gained increased interest, there is a paucity of data on rehabilitation in patients undergoing LRT. Frailty is one of the few modifiable risk factors of retransplantation that is potentially preventable. As such, it is imperative that professionals involved in the field of retransplantation conduct research specifically exploring rehabilitative techniques and outcomes of value for patients receiving LRT, because this area remains unexplored.
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Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Integration, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Robert M Reed
- Department of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, USA
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Mei J, Hu J, Krause EM, Chen-Yoshikawa TF, Alvarez A, Wang X. The efficacy of pulmonary rehabilitation training program for patients after lung transplantation. J Thorac Dis 2024; 16:530-541. [PMID: 38410547 PMCID: PMC10894442 DOI: 10.21037/jtd-23-1774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/03/2024] [Indexed: 02/28/2024]
Abstract
Background Pulmonary rehabilitation is recognized widely as one of the most effective measures to promote postoperative recovery of lung transplant recipients (LTRs), and it has positive effects on both short- and long-term quality of life (QoL) and survival outcomes. However, no standardized pulmonary rehabilitation training programs exist specifically for LTRs. The pulmonary rehabilitation programs widely used in clinical practice focus mainly on exercise or respiratory training, to some extent neglecting other therapeutic methods that could promote patient health, such as nutrition support, pain control, spiritual comfort, and so on. This study aimed to develop a postoperative pulmonary rehabilitation training program for LTRs and evaluate its effectiveness. Methods Using convenience sampling, all patients who underwent lung transplantation (LTx) at Shanghai Pulmonary Hospital from January 2021 to December 2022 were screened for inclusion and exclusion criteria, and a total of 68 patients were finally included in this study. A non-synchronous quasi-experimental design was used, with patients who underwent LTx in 2021 as the control group and patients who underwent LTx in 2022 as the experimental group. The control group received routine treatment, health education, and rehabilitation guidance when patients determined the date of surgery. In addition to this, the experimental group received pulmonary rehabilitation training. The incidence of postoperative pulmonary complications (pulmonary infections), duration of chest tube drainage, intensive care unit (ICU) length of stay, postoperative pain scores, postoperative QoL, pulmonary function, oxygenation index, and the distance in the 6-minute walking test (6MWD) were compared between the two groups. Results The length of ICU stay and duration of chest tube drainage in the experimental group were lower than those in the control group, and the results of oxygenation index, 6MWD, and St. George's Respiratory Questionnaire (reflecting the QoL) were better than those of the control group (P<0.05). There was no significant difference in the pain of the two groups 1 week after surgery and 3 months after surgery, and the pain score of the experimental group was lower than that of the control group at 1 month after surgery (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusions The postoperative pulmonary rehabilitation training program for LTRs is safe and effective. It can shorten both the duration of chest tube drainage and ICU stay, it can also improve patients' exercise capacity and pulmonary function while also promote safety outcomes of LTRs, and improve QoL scores.
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Affiliation(s)
- Jie Mei
- Department of Operating Room, Shanghai Pulmonary Hospital, Shanghai, China
| | - Jing Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai, China
| | - Eric M. Krause
- Division of Thoracic Surgery, University of Maryland, Baltimore, MD, USA
| | | | - Antonio Alvarez
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Reina Sofía, Córdoba, Spain
| | - Xiaojun Wang
- Department of Operating Room, Shanghai Pulmonary Hospital, Shanghai, China
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Hagiyama A, Sugimoto S, Tanaka S, Matsubara K, Miyoshi K, Katayama Y, Hamada M, Senda M, Toyooka S. Impact of changes in skeletal muscle mass and quality during the waiting time on outcomes of lung transplantation. Clin Transplant 2024; 38:e15169. [PMID: 37882504 DOI: 10.1111/ctr.15169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/24/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION The association of changes in skeletal muscle mass and quality during the waiting time with outcomes of lung transplantation (LT) remains unclear. We aimed to examine the association of changes in skeletal muscle mass and quality during the waiting time, as well as preoperative skeletal muscle mass and quality, with outcomes of LT. METHODS This study included individuals who underwent LT from brain-dead donors. Skeletal muscle mass (cm2 /m2 ) and quality (mean Hounsfield units [HU]) of the erector spinae muscle at the 12th thoracic level were evaluated using computed tomography. Preoperative skeletal muscle mass and quality, and their changes during the waiting time were calculated. We evaluated the associations among mechanical ventilation (MV) duration, intensive care unit (ICU) length of stay (LOS), hospital LOS, 6-minute walk distance at discharge, and 5-year survival after LT. RESULTS This study included 98 patients. The median waiting time was 594.5 days (interquartile range [IQR], 355.0-913.0). The median changes in skeletal muscle mass and quality were -4.4% (IQR, -13.3-3.1) and -2.9% (IQR, -16.0-4.1), respectively. Severe low skeletal muscle mass at LT was associated with prolonged ICU LOS (B = 8.46, 95% confidence interval [CI]: .51-16.42) and hospital LOS (B = 36.00, 95% CI: 3.23-68.78). Pronounced decrease in skeletal muscle mass during the waiting time was associated with prolonged MV duration (B = 7.85, 95% CI: .89-14.81) and ICU LOS (B = 7.97, 95% CI: .83-15.10). CONCLUSION Maintaining or increasing skeletal muscle mass during the waiting time would be beneficial to improve the short-term outcomes of LT.
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Affiliation(s)
- Akikazu Hagiyama
- Division of Physical Medicine and Rehabilitation, Okayama University Hospital, Okayama, Japan
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Seiichiro Sugimoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Shin Tanaka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Kei Matsubara
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Kentaroh Miyoshi
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yoshimi Katayama
- Division of Physical Medicine and Rehabilitation, Okayama University Hospital, Okayama, Japan
| | - Masanori Hamada
- Division of Physical Medicine and Rehabilitation, Okayama University Hospital, Okayama, Japan
| | - Masuo Senda
- Division of Physical Medicine and Rehabilitation, Okayama University Hospital, Okayama, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Zhang D, Yu L, Xia B, Zhang X, Liang P, Hu X. Systematic review and meta-analysis of the efficacy of exercise intervention in kidney transplant recipients. World J Urol 2023; 41:3449-3469. [PMID: 37882807 DOI: 10.1007/s00345-023-04673-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVE There is uncertainty about the beneficial effects of exercise intervention for kidney transplant recipients. The purpose of our meta-analysis is to estimate the efficacy of exercise intervention in kidney transplant recipients. METHODS A database search according to the PICOS framework was performed for all published randomized, double-blind, placebo-controlled trials (RCTs) about exercise intervention for kidney transplant recipients. The databases involved include PubMed, Embase, and Cochrane Library. RESULTS A total of 16 RCTs (involving 827 patients) in compliance with inclusion criteria were included in our study. The results demonstrated that adequate exercise intervention improved statistically in creatinine clearance [mean difference (MD) = - 0.29, 95% confidence interval (CI) - 0.46 to - 0.11, p = 0.001], serum urea (MD = - 21.57, 95% CI - 35.84 to - 7.29, p = 0.003), VO2 peak (MD = 3.20, 95% CI 1.97-4.43, p < 0.00001), high-density lipoprotein-cholesterol (HDL-C) (MD = 0.21, 95% CI 0.04-0.37, p = 0.01), 60-s sit to stand test (60-STS) (MD = 14.47, 95% CI 8.89-20.04, p < 0.00001), 6-min walk distance (6-MWD) (MD = 91.87, 95% CI 38.34-145.39, p = 0.0008), and 6-min walk test (6-MWT) (MD = 44.08, 95% CI 20.30-67.87, p = 0.0003) of patients after kidney transplantation. No between-groups differences (p > 0.05) were observed for anthropometric characteristics, body composition, serum cytokine levels, and quality of life short form-36 questionnaire (SF-36). CONCLUSIONS In kidney transplant recipients, appropriate exercise intervention improved renal function, cardiopulmonary function, physical performance. TRIAL REGISTRATION The PROSPERO registration number is CRD42022357574.
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Affiliation(s)
- Dongxu Zhang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Institute of Urology, Capital Medical University, Beijing, China
| | - Liqian Yu
- Qingdao University Medical College, Qingdao, China
| | - Bowen Xia
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Institute of Urology, Capital Medical University, Beijing, China
| | - Xin Zhang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Institute of Urology, Capital Medical University, Beijing, China
| | - Pu Liang
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
- Beijing Institute of Infectious Diseases, Beijing, China.
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China.
| | - Xiaopeng Hu
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
- Institute of Urology, Capital Medical University, Beijing, China.
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Sunder T, Ramesh Thangaraj P, Kumar Kuppusamy M, Balasubramanian Sriraman K, Selvi and
Srinivasan Yaswanth Kumar C. Lung Transplantation for Pulmonary Artery Hypertension. NEW INSIGHTS ON PULMONARY HYPERTENSION [WORKING TITLE] 2023. [DOI: 10.5772/intechopen.1002961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
This manuscript discusses the role of lung transplantation in patients with pulmonary hypertension. The indications and timing for referral to a transplant unit and timing for wait-listing for lung transplantation are discussed. The type of transplantation—isolated (single or double) lung transplantation and situations when combined heart and double lung transplantation is indicated—will be elaborated. Escalation of medical therapy with the need and timing for bridging therapies such as extracorporeal membrane oxygenation until an appropriate organ becomes available will be discussed. Challenges in the postoperative period, specific to lung transplantation for pulmonary artery hypertension, will be reviewed. The outcomes following lung transplantation will also be considered in greater detail.
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Mathur S, Janaudis-Ferreira T, Ferreira MDP, Bourgeois N, Blydt-Hansen T, Fuller T, Deliva R, Hamiwka L. La collecte de données probantes sur l’exercice en cas de transplantation d’organe plein : à quel point avons-nous progressé? Physiother Can 2023; 75:212-214. [PMID: 37736412 PMCID: PMC10510543 DOI: 10.3138/ptc-2022-0111-fr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Affiliation(s)
- Sunita Mathur
- École des sciences de la réadaptation, Université Queen’s, Kingston (Ontario) Canada
- Programme canadien de recherche en don et transplantation du Canada, Université de l’Alberta, Edmonton (Alberta) Canada
| | - Tania Janaudis-Ferreira
- Programme canadien de recherche en don et transplantation du Canada, Université de l’Alberta, Edmonton (Alberta) Canada
- École de physiothérapie et d’ergothérapie, Université McGill, Montréal (Québec) Canada
| | - Manoela de Paula Ferreira
- Programme canadien de recherche en don et transplantation du Canada, Université de l’Alberta, Edmonton (Alberta) Canada
- Département de physiothérapie, Université de Toronto, Toronto (Ontario) Canada
| | - Nicholas Bourgeois
- Programme canadien de recherche en don et transplantation du Canada, Université de l’Alberta, Edmonton (Alberta) Canada
- École de physiothérapie et d’ergothérapie, Université McGill, Montréal (Québec) Canada
- Centre hospitalier de l’Université de Montréal, Montréal (Québec) Canada
| | - Tom Blydt-Hansen
- Programme canadien de recherche en don et transplantation du Canada, Université de l’Alberta, Edmonton (Alberta) Canada
- Département de pédiatrie (néphrologie), Université de la Colombie-Britannique, Vancouver (Colombie-Britannique) Canada
| | - Tracy Fuller
- London Health Sciences Centre, London (Ontario) Canada
| | - Robin Deliva
- The Hospital for Sick Children, Toronto (Ontario) Canada
| | - Lorraine Hamiwka
- Programme canadien de recherche en don et transplantation du Canada, département de pédiatrie, Alberta Children’s Hospital, École de médecine Cumming, Université de Calgary (Alberta) Canada
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Mathur S, Janaudis-Ferreira T, de Paula Ferreira M, Bourgeois N, Blydt-Hansen T, Fuller T, Deliva R, Hamiwka L. Building the Evidence for Exercise in Solid Organ Transplant: How Far Have We Moved the Needle? Physiother Can 2023; 75:209-211. [PMID: 37736416 PMCID: PMC10510535 DOI: 10.3138/ptc-2022-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 09/23/2023]
Affiliation(s)
- Sunita Mathur
- From the:
School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
- Canadian Donation and Transplantation Research Program, University of Alberta, Edmonton, Alberta, Canada
| | - Tania Janaudis-Ferreira
- Canadian Donation and Transplantation Research Program, University of Alberta, Edmonton, Alberta, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Manoela de Paula Ferreira
- Canadian Donation and Transplantation Research Program, University of Alberta, Edmonton, Alberta, Canada
- Dept of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Bourgeois
- Canadian Donation and Transplantation Research Program, University of Alberta, Edmonton, Alberta, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Tom Blydt-Hansen
- Canadian Donation and Transplantation Research Program, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics (Nephrology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Tracy Fuller
- London Health Sciences Centre, London, Ontario, Canada
| | - Robin Deliva
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lorraine Hamiwka
- Department of Pediatrics, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Canadian Donation and Transplantation Research Program
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Polastri M, Dell'Amore A, Reed RM, Pehlivan E. Handgrip Strength in Lung Transplant Candidates and Recipients. EXP CLIN TRANSPLANT 2023; 21:547-555. [PMID: 37486028 DOI: 10.6002/ect.2023.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
OBJECTIVES Handgrip strength is increasingly used to assess muscle strength in various conditions. In this review, we investigated handgrip strength in patients receiving or awaiting lung transplant. MATERIALS AND METHODS For this integrative review, we searched 8 databases from inception through February 2023. Two keyword entries, "handgrip strength" and "lung transplantation," were matched using the Boolean operator, AND. No filters were applied for document type, age, sex, publication date, language, and subject. RESULTS AND CONCLUSIONS The searched databases returned 73 citations. Nine articles considering 487 patients (49% female) were included in the final analysis; 7 studies were observational, and 2 were randomized controlled trials. In 7 of 9 studies, handgrip strength was measured with a hydraulic dynamometer. In candidates for lung transplant, handgrip strength ranged from 27.1 kg (before rehabilitation) to 31.2 kg (after rehabilitation). In lung transplant recipients, handgrip strength ranged from 21.1 kg (before rehabilitation) to 35.7 kg (after rehabilitation). Handgrip strength in lung transplant candidates with chronic obstructive pulmonary disease was higher (89 ± 18% predicted) versus patients with interstitial lung disease (79 ± 18% predicted). Improvements in maximal inspiratory pressure and maximal expiratory pressure were observed in those patients whose handgrip strength improved after rehabilitation. Nonsarcopenic patients walked longer distances for the 6-minute walking test (>450 m) versus sarcopenic patients (<310 m) and had higher handgrip strength (>20 kg) versus sarcopenic patients (<20 kg). Handgrip strength testing should be implemented both in preoperative and postoperative contexts to evaluate physical potential of patients and drive rehabilitative activities toward the most impaired domains.
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Affiliation(s)
- Massimiliano Polastri
- From the Department of Continuity of Care and Integration, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Design of Lung Transplant Go (LTGO): A randomized controlled trial evaluating the efficacy of a telerehabilitation behavioral exercise intervention to improve physical activity, physical function, and blood pressure control after lung transplantation. Contemp Clin Trials Commun 2023; 33:101097. [PMID: 36911577 PMCID: PMC9999171 DOI: 10.1016/j.conctc.2023.101097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/22/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
Background Lung transplantation is an established treatment option for persons with advanced lung disease. After transplantation, lung function typically returns to near normal levels, however exercise capacity remains low due to chronic deconditioning, limited physical function, and inactive lifestyles which undermine the intended benefits of the highly selective, resource-intensive transplant procedure. Pulmonary rehabilitation is recommended to improve fitness and activity tolerance, however due to multiple barriers, lung transplant recipients either never participate, or fail to complete, pulmonary rehabilitation programs. Purpose To describe the design of Lung Transplant Go (LTGO), a trial modified for the remote environment based on recommendations to preserve trial integrity during COVID. The aims are to evaluate a behavioral exercise intervention to improve physical function, physical activity, and blood pressure control in lung transplant recipients conducted safely and effectively using a telerehabilitation (telerehab) platform, and to explore the role of potential mediators and moderators of the relationship between LTGO and outcomes. Methods Single-site, 2-group randomized controlled trial with lung transplant recipients randomized 1:1 to either the LTGO intervention (a 2-phased, supervised, telerehab behavioral exercise program), or to enhanced usual care (activity tracking and monthly newsletters). All study activities, including intervention delivery, recruitment, consenting, assessment, and data collection, will be performed remotely. Conclusion If efficacious, this fully scalable and replicable telerehab intervention could be efficiently translated to reach large numbers of lung recipients to improve and sustain self-management of exercise habits by overcoming barriers to participation in existing, in-person pulmonary rehabilitation programs.
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Just IA, Fries D, Loewe S, Falk V, Cesarovic N, Kemper D, Edelmann F, Feuerstein A, Haufe FL, Xiloyannis M, Riener R, Schoenrath F. Movement therapy in lung transplantation candidates assisted by a lightweight wearable robot. Assist Technol 2023; 35:242-247. [PMID: 35438604 DOI: 10.1080/10400435.2022.2067914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 10/18/2022] Open
Abstract
The aim of this pilot-study was to investigate the safety, feasibility and tolerability of an assisted mobilization of patients with advanced pulmonary diseases, using a lightweight, exoskeleton-type robot (Myosuit, MyoSwiss AG, Zurich, Switzerland). Ten patients performed activities of daily life (ADL) both with and without the device. The mean age was 53.6 (±5.6) years; 70% were male. The assessment of outcome included the evaluation of vital signs, adverse events, rates of perceived exertion and dyspnea (PRE, PRD), the ability to perform ADL and the individual acceptability. Robotic-assisted mobilization was feasible in all patients. No adverse events occurred. RPE and RPD showed no significant difference with or without the Myosuit (mean difference in RPE -1.7, 95%-confidence interval (CI) -1.16, 4.49; p = 0.211; mean difference in RPD 0.00, 95%-CI -1.88, 1.88; p = 0.475). 80% of patients were interested to participate in a robotic-assisted training on a regular basis. A robotic exoskeleton-assisted mobilization is safe, feasible, well-tolerated and well-accepted. The results are highly encouraging to further pursue this highly innovative approach.
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Affiliation(s)
- Isabell Anna Just
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Denis Fries
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Sina Loewe
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin
- Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland
| | - Nikola Cesarovic
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Translational Cardiovascular Technologies, Department of Health Sciences, ETH Zürich, Switzerland
| | - Dagmar Kemper
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Anna Feuerstein
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Florian L Haufe
- Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Michele Xiloyannis
- Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Robert Riener
- Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin
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Santana Shiguemoto T, Janaudis-Ferreira T, Dewan N, Mathur S. Identifying Outcome Domains for Clinical Trials of Physical Rehabilitation Among Adults Undergoing Solid Organ Transplantation Using a Delphi Approach. Prog Transplant 2023; 33:50-60. [PMID: 36510644 PMCID: PMC9968996 DOI: 10.1177/15269248221145032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: A core outcome set (COS) improves the quality of reporting in clinical trials; however, this has not been developed for clinical trials of exercise training among adults undergoing solid organ transplant. Research Question: To explore the perspectives of transplant patients and healthcare professionals on the key outcomes domains that are relevant for clinical trials of exercise in all recipients of transplanted organs. Methods: A Delphi approach was employed with 2 rounds of online questionnaires. Participants rated the importance of outcome domains using a 9-point Likert scale ranging from "not important" to "very important". A score of 7 to 9 (very important) by 70% or more participants and a score of 1 to 3 (not important) by less than 15% participants were required to keep an outcome domain from the first to the second round. Results: Thirty-six participants completed 2 rounds of questionnaires (90% response rate). After Round 1, 8 outcome domains were considered very important in the pretransplant phase; 16 in the early posttransplant; and 17 in the late posttransplant. Only 1 outcome domain, organ rejection in the early posttransplant phase, met the criteria to be considered very important after Round 2. Conclusion: Although consensus was not reached on the core outcome domains, this study provides preliminary information on which domains are higher priority for patients and professionals. Future work should consider a meeting with key stakeholders to allow for deeper discussion to reach consensus on a core outcome set.
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Affiliation(s)
| | - Tania Janaudis-Ferreira
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Centre for Health Outcomes Research (CORE), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University Health Center, Montreal, Quebec, Canada.,Canadian Donation and Transplantation Research Program (CDTRP), University of Alberta, Edmonton, Alberta, Canada
| | - Neha Dewan
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Canadian Donation and Transplantation Research Program (CDTRP), University of Alberta, Edmonton, Alberta, Canada.,School of Rehabilitation Therapy, 4257Queen's University, Kingston, Ontario, Canada
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Lung Transplant Rehabilitation-A Review. Life (Basel) 2023; 13:life13020506. [PMID: 36836863 PMCID: PMC9962622 DOI: 10.3390/life13020506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Both lung transplant recipients and candidates are characterised by reduced training capacity and low average quality of life (QoL). This review investigates the impact of training on exercise ability and QoL in patients before and after lung transplant. METHODS Searches were conducted from the beginning to 7 March 2022 using the terms "exercise," "rehabilitation," "lung transplant," "exercise ability," "survival," "quality of life" and "telerehabilitation" in six databases, including Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, CINAHL, Nursing and Allied Health, and Scopus. The inclusion criteria were studies evaluating the effects of an exercise training programme concurrent with lung transplantation as well as patients and candidates (>18 years old) through any lung diseases. The term "lung transplant rehabilitation" was used to refer to all carefully thought-out physical activities with the ultimate or intermediate objective of improving or maintaining physical health. RESULTS Out of 1422 articles, 10 clinical- and 3 telerehabilitation studies, candidates (n = 420) and recipients (n = 116) were related to the criteria and included in this review. The main outcome significantly improved in all studies. The 6-min walk distance, maximum exercise capacity, peak oxygen uptake, or endurance for constant load rate cycling improved measuring physical activity [aerobic exercises, breathing training, and aerobic and inspiratory muscle training sessions (IMT)]. Overall scores for dyspnoea improved after exercise training. Furthermore, health-related quality of life (HRQOL) also improved after aerobic exercise training, which was performed unsupervised or accompanied by breathing sessions. Aerobic training alone rather than combined with inspiratory muscle- (IMT) or breathing training enhanced exercise capacity. CONCLUSION In conclusion, rehabilitation programmes seem to be beneficial to patients both preceding and following lung transplantation. More studies are required to determine the best training settings in terms of time scale, frequency, and work intensity in terms of improving exercise ability, dyspnoea, and HRQOL.
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Time Trends in Clinical Characteristics and Hospital Outcomes of Hospitalizations for Lung Transplantation in COPD Patients in Spain from 2016 to 2020-Impact of the COVID-19 Pandemic. J Clin Med 2023; 12:jcm12030963. [PMID: 36769611 PMCID: PMC9917456 DOI: 10.3390/jcm12030963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
(1) Background: To examine the clinical characteristics and hospital outcomes of hospitalization for lung transplantation in COPD patients in Spain from 2016 to 2020; and to assess if the COVID-19 pandemic has affected the number or the outcomes of lung transplantations in these patients. (2) Methods: We used the Spanish National Hospital Discharge Database to select subjects who had a code for COPD (ICD-10: J44) and had undergone a lung transplantation (ICD-10 codes OBYxxxx). (3) Results: During the study period, 704 lung transplants were performed among COPD patients (single 31.68%, bilateral 68.32%). The absolute number of transplants increased with raising rates of 8%, 14% and 19% annually from 2016 to 2019. However, a marked decrease of -18% was observed from 2019 to year 2020. Overall, 47.44% of the patients suffered at least one complication, being the most frequent lung transplant rejection (24.15%), followed by lung transplant infection (13.35%). The median length of hospital stay (LOHS) was 33 days and the in-hospital-mortality (IHM) was 9.94%. Variables associated with increased risk of mortality were a Comorbidity Charlson Index ≥ 1 (OR 1.82; 95%CI 1.08-3.05) and suffering any complication of the lung transplantation (OR 2.14; 95%CI 1.27-3.6). COPD patients in 2020 had a CCI ≥ 1 in a lower proportion than 2019 patients (29.37 vs. 38.51%; p = 0.015) and less frequently suffered any complications after the lung transplantation (41.26 vs. 54.6%; p = 0.013), no changes in the LOHS or the IHM were detected from 2019 to 2020. (4) Conclusions: Our study showed a constant increase in the number of lung transplantations from 2016 to 2019 in COPD patients, with a drop from 2019 to 2020, probably related to the COVID-19 pandemic. However, no changes in LOHS or IHM were detected over time.
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Hergenroeder AL, Willey B, Vendetti M, Dabbs AD. Exercise Progression Protocol for Lung Transplant GO: A Multicomponent Telerehab Exercise Intervention for Patients After Lung Transplantation. Cardiopulm Phys Ther J 2023; 34:2-12. [PMID: 36644217 PMCID: PMC9838685 DOI: 10.1097/cpt.0000000000000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Lung transplantation is one of the fastest growing solid organ transplant procedures in the United States. After transplantation, lung function typically returns to near normal levels; however, reduced physical function and an inactive lifestyle compromise this benefit. To promote rehabilitation goals, lung transplant recipients (LTRs) are advised to participate in pulmonary rehab, but participation is low due to barriers related to scheduling, travel requirements, lack of insurance coverage, and the concern about exposure to infection. Telerehabilitation offers a flexible alternative with the potential to promote self-management of exercise in LTRs. The purpose of this report was to describe the exercise progression protocol for the Lung Transplant GO multicomponent telerehab exercise intervention for patients after lung transplantation. The progression protocol is an evidence-informed exercise protocol designed to improve physical function and physical activity in LTRs safely and effectively in a remote environment. The protocol standardizes the prescription of exercise while permitting adaptation of the program to meet the needs of the individual. Using this model, the decisions about program progression are systematic, transparent, and replicable to other LTRs.
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Early Change in Lower Limb Strength and Function in Lung Transplant Patients After Center-Based and Telerehabilitation. J Cardiopulm Rehabil Prev 2023; 43:55-60. [PMID: 35961370 DOI: 10.1097/hcr.0000000000000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of this study was to examine the change and relationship among quadriceps torque (QT) and physical function in adult lung transplant (LTx) patients undergoing rehabilitation. METHODS A prospective study assessed 6-min walk test (6MWT) distance, QT, and Short Physical Performance Battery (SPPB) at the start of pre-habilitation and 10-12 wk post-LTx. Functional outcomes were examined for within-group differences for participants who completed center-based rehabilitation between September 2019 and March 2020 and participants who completed telerehabilitation ("telerehab") between March 2020 and June 2021 during COVID-19. Relationships between QT, SPPB, and 6MWT were examined pre- and post-LTx. RESULTS A total of 49 LTx recipients were included (30 men, 61 [56-67] yr, 26 center-based rehab, and 23 telerehab). The 6MWT increased (median 75 m: 95% CI, 35 - 117, P < .0001), and the telerehab group showed an LTx decrease in QT (-9.6 Nm: 95% CI, -29 to -2.3, P = .02) and an increased gait speed (0.21 m/sec: 95% CI, 0.11 - 0.47, P < .0001). Pre-LTx QT showed a moderate correlation to pre-LTx SPPB ( r = 0.41, P = .004) and weak correlations to gait speed and 6MWT ( r ranging from 0.21 to 0.35, P < .05). Post-LTx QT showed moderate correlations to post-LTx SPPB ( r = 0.43, P = .002), gait speed ( r = 0.54, P < .001), five-time sit-to-stand ( r =-0.57, P < .0001), and 6MWT ( r = 0.62, P < .0001). CONCLUSIONS Early post-LTx 6MWT and gait speed increased with no improvement in QT or other SPPB components. Correlations between QT and measures of exercise capacity and lower limb function were stronger post-LTx. Serial measurements may further inform functional trajectories and rehabilitation models.
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Mathur S, Dewan N, Janaudis-Ferreira T, Antonio P, Surins H, Deliva R, Patterson C, So S. Disseminating education to solid organ transplant recipients to promote engagement in physical activity. PEC INNOVATION 2022; 1:100024. [PMID: 37213783 PMCID: PMC10194172 DOI: 10.1016/j.pecinn.2022.100024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/28/2022] [Accepted: 02/13/2022] [Indexed: 05/23/2023]
Abstract
Objective To evaluate the dissemination of education through a workshop to promote engagement in physical activity (PA) among solid organ transplant (SOT) recipients. Methods The in-person workshop consisted of expert-led lectures on topics related to physical activity (day 1) and sports and fitness training with volunteer coaches (day 2). There were separate streams for children/adolescents and adults. RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework was used to evaluate the impact of the workshop. Presenters and participants completed evaluations of the workshop using a 5-point Likert scale. A subgroup of adults completed a self-reported PA questionnaire at baseline and 4-weeks after the workshop. Results 103 individuals (71 SOT recipients, 32 caregivers) attended the workshop (ages 4 to 71+ years). Sessions were highly rated (median = 5) for both quality and content on both days. There was no significant change (p = 0.16) in PA. However, 56% of SOT recipients reported changing their level of PA. Conclusion An educational-workshop with hands-on training was an efficient and well-received method for disseminating awareness about the benefits of PA in SOT recipients. Innovation Dissemination of evidence-based knowledge through a novel educational-workshop in a real-world setting has the potential to inform the decisions about PA behavior among SOT recipients.
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Affiliation(s)
- Sunita Mathur
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | - Neha Dewan
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Tania Janaudis-Ferreira
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, Canada
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Patrick Antonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Holly Surins
- Department of Occupational Therapy and Occupational Science, University of Toronto, Toronto, Canada
| | - Robin Deliva
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Department of Rehabilitation Services, Hospital for Sick Children (SickKids), Toronto, Canada
| | - Catherine Patterson
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Department of Rehabilitation Services, Hospital for Sick Children (SickKids), Toronto, Canada
| | - Stephanie So
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Department of Rehabilitation Services, Hospital for Sick Children (SickKids), Toronto, Canada
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Hume E, Muse H, Wallace K, Wilkinson M, Heslop Marshall K, Nair A, Clark S, Vogiatzis I. Feasibility and acceptability of a physical activity behavioural modification tele-coaching intervention in lung transplant recipients. Chron Respir Dis 2022; 19:14799731221116588. [PMID: 36306548 PMCID: PMC9619269 DOI: 10.1177/14799731221116588] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite improvements in pulmonary function following lung transplantation (LTx), physical activity levels remain significantly lower than the general population. To date, there is little research investigating interventions to improve daily physical activity in LTx recipients. This study assessed the feasibility and acceptability of a novel, 12-weeks physical activity tele-coaching (TC) intervention in LTx recipients. METHODS Lung transplant recipients within 2 months of hospital discharge were recruited and randomised (1:1) to TC or usual care (UC). TC consists of a pedometer and smartphone app, allowing transmission of activity data to a platform that provides feedback, activity goals, education, and contact with the researcher as required. Recruitment and retention, occurrence of adverse events, intervention acceptability and usage were used to assess feasibility. RESULTS Key criteria for progressing to a larger study were met. Of the 15 patients eligible, 14 were recruited and randomised to TC or UC and 12 completed (67% male; mean ± SD age; 58 ± 7 years; COPD n = 4, ILD n = 6, CF n = 1, PH n = 1): TC (n = 7) and UC (n = 5). TC was well accepted by patients, with 86% indicating that they enjoyed taking part. Usage of the pedometer was excellent, with all patients wearing it for over 90% of days and rating the pedometer and telephone contact as the most vital aspects. There were no adverse events related to the intervention. After 12 weeks, only TC displayed improvements in accelerometry steps/day (by 3475 ± 3422; p = .036) and movement intensity (by 153 ± 166 VMU; p = .019), whereas both TC and UC groups exhibited clinically important changes in physical SF-36 scores (by 11 ± 14 and 7 ± 9 points, respectively). CONCLUSION TC appears to be a feasible, safe, and well-accepted intervention in LTx.
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Affiliation(s)
- Emily Hume
- Department of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK,Emily HumeDepartment of Sport, Exercise and Rehabilitation, Faculty of Health and Life sciences, Northumbria University, Northumberland Building, Newcastle upon Tyne NE1 8ST, UK.
| | - Hazel Muse
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kirstie Wallace
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mick Wilkinson
- Department of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | | | - Arun Nair
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephen Clark
- Department of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK,The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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Herrmann T, Iglesias J, Smith S. Interdisciplinary Management for the First Patient With Post-COVID Double-Lung Transplantation in Inpatient Rehabilitation in the United States: A Case Report. Phys Ther 2022; 102:6596554. [PMID: 35648112 PMCID: PMC9384169 DOI: 10.1093/ptj/pzac070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/11/2022] [Accepted: 05/01/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In the setting of the COVID-19 pandemic, lung transplantation is being used as a life-saving treatment. This case report describes the rehabilitation course of the first documented individual in the United States post bilateral lung transplant for COVID-19. METHODS (CASE DESCRIPTION) The patient is a 28-year-old woman who was previously healthy and who failed all other life-saving medical interventions before undergoing bilateral lung transplantation, resulting in an extended hospital stay and significant physical debility. RESULTS Through an interdisciplinary rehabilitation approach, the patient was able to achieve functional improvements in strength, balance, endurance, and functional mobility to safely discharge home. CONCLUSION Research is needed regarding optimal treatment of this patient population because lung transplantation continues to be used for long-term medical management of COVID-19 infection. IMPACT This is a case report describing rehabilitation for the first documented individual in the United States post bilateral lung transplant for COVID-19.
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Affiliation(s)
- Tessa Herrmann
- *Corresponding Author: Tessa Herrmann, Physical Therapist,
| | - Jacqueline Iglesias
- Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago) 355 E Erie, Chicago, IL 60611
| | - Samantha Smith
- Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago) 355 E Erie, Chicago, IL 60611
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24
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Lee SH. Awakening in extracorporeal membrane oxygenation as a bridge to lung transplantation. Acute Crit Care 2022; 37:26-34. [PMID: 35279976 PMCID: PMC8918718 DOI: 10.4266/acc.2022.00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/12/2022] [Indexed: 12/01/2022] Open
Abstract
Although the rate of lung transplantation (LTx), the last treatment option for end-stage lung disease, is increasing, some patients waiting for LTx need a bridging strategy for LTx due to the limited number of available donor lungs. For a long time, mechanical ventilation has been employed as a bridge to LTx because the outcome of using extracorporeal membrane oxygenation (ECMO) as a bridging strategy has been poor. However, the outcome after mechanical ventilation as a bridge to LTx was poor compared with that in patients without bridges. With advances in technology and the accumulation of experience, the outcome of ECMO as a bridge to LTx has improved, and the rate of ECMO use as a bridging strategy has increased over time. However, whether the use of ECMO as a bridge to LTx can achieve survival rates similar to those of non-bridged LTx patients remains controversial. In 2010, one center introduced awake ECMO strategy for LTx bridging, and its use as a bridge to LTx has been showing favorable outcomes to date. Awake ECMO has several advantages, such as maintenance of physical activity, spontaneous breathing, avoidance of endotracheal intubation, and reduced use of sedatives and analgesics, but it may cause serious problems. Nonetheless, several studies have shown that awake ECMO performed by a multidisciplinary team is safe. In cases where ECMO or mechanical ventilation is required due to unavoidable exacerbation in patients awaiting LTx, the application of awake ECMO performed by an appropriately trained ECMO multi-disciplinary team can be useful.
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25
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Polastri M, Loforte A, Dell'Amore A, Swol J. Physiotherapy and artificial lungs: looking to the future. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2021.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, St Orsola University Hospital, Bologna, Italy
- Critical and Respiratory Care Unit, University Hospital of Bologna, Scientific Institute for Research, Hospitalization and Healthcare, Bologna, Italy
| | - Antonio Loforte
- Division of Cardiac Surgery, University Hospital of Bologna, Scientific Institute for Research, Hospitalization and Healthcare, Bologna, Italy
| | | | - Justyna Swol
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University General Hospital, Nuremberg, Germany
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Abstract
The rehabilitation needs of individuals undergoing thoracic surgery are changing, especially as surgical management is increasingly being offered to patients who are at risk of developing functional limitations during and after hospital discharge. In the past rehabilitative management of these patients was frequently limited to specific respiratory physiotherapy interventions in the immediate postoperative setting with the aim to prevent postoperative pulmonary complications. In the past two decades, this focus has shifted toward pulmonary rehabilitation interventions that aim to improve functional status of individuals, both in the pre- and (longer-term) postoperative period. While there is increased interest in (p)rehabilitation interventions the majority of thoracic surgery patients are however currently on their own with respect to progression of their exercise and physical activity regimens after they have been discharged from hospital. There are also no formal guidelines supporting the referral of these patients to outpatient rehabilitation programs. The current evidence regarding rehabilitation interventions initiated before, during, and after the hospitalization period will be briefly reviewed with special focus on patients undergoing surgery for lung cancer treatment and patients undergoing lung transplantation. More research will be necessary in the coming years to modify or change clinical rehabilitation practice beyond the acute admission phase in patients undergoing thoracic surgery. Tele rehabilitation or web-based activity counseling programs might also be interesting emerging alternatives in the (long-term) postoperative rehabilitative treatment of these patients.
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Affiliation(s)
- Daniel Langer
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Department of Respiratory Diseases, UZ Leuven, BREATHE Department CHROMETA, KU Leuven, Leuven, Belgium
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