|Topic:||35. Transplantation / Adult / Clinical Studies / Clinical Problems (CP)|
|Authors:||G.S. Bauldoff1, V. Van Berkel2, M. Fox2, A. Ramirez2, D.R. Nunley2; 1Columbus, OH/US, 2Louisville, KY/US|
Introduction: Some prospective candidates may be considered too frail to benefit from lung transplantation (LTX). The inability to attain a minimum distance of 800 feet on a six-minute walk test (6 MWD) has been proposed as a marker of frailty and discriminator for deciding potential benefit from LTX. Unclear is whether post-transplant outcomes can be enhanced through pre-transplant pulmonary rehabilitation (P-TPR).
Methods: A retrospective review was performed of patients who were wait-listed and subsequently transplanted between 1/1/10 and 12/31/14. When wait-listed all patients were enrolled in a P-TPR program where their 6MWDs were sequentially monitored. Following transplant, patients were partitioned based on the 6MWD attained when they first entered P-TPR - those who initially walked > 800 feet and those who walked < 800 feet. Patients were analyzed with respect to post-transplant survival, in-hospital days, and inpatient rehabilitation days.
Results: Sixty-eight patients met the inclusion criteria; 36 of them attaining > 800 feet on their initial 6MWD while 32 walked < 800 feet. There was no difference in total days spent in P-TPR between these two groups (452.1 + 322.8 vs. 405.0 + 320.6, p=0.55), nor in their one-year post-transplant survival (p=0.93). Sub-analysis of only the 32 patients who initially walked < 800 feet revealed no difference in one-year post-transplant survival between those who improved their 6MWD to > 800 feet prior to transplant (n=9) and those who did not (n=23) [p=0.62]. During the first post-transplant year those patients who had walked < 800 feet experienced a significantly higher percentage of in-hospital days compared to those who had initially walked > 800 feet (20.6% vs 18.4%, p=0.04) and also required a higher percentage of additional days in an inpatient rehabilitation facility (3.2% vs 3.0%, p=0.02). Likewise, those who initially walked < 800 feet but improved their 6MWD through P-TPR experienced a comparable percentage of days in the hospital (11.9% vs 24.0%, p=0.21) and in inpatient rehabilitation (2.9% vs 3.3%, p=0.05) compared to those who did not improve their P-TPR 6MWD.
Conclusion: The inability to attain a 6MWD of > 800 feet should not be used as the sole criterion for deciding whether a patient should be wait-listed for LTX, although they will require more post-transplant utilization of inpatient services. In those who cannot walk at least 800 feet, the ability to improve 6MWD through P-TPR has no impact on one-year post-transplant survival or on the utilization of post-transplant inpatient services.