Cardiopulmonary exercise testing before and after lung and heart-lung transplantation

Heart-lung (HLT) and lung transplantation (LT) have been shown to be effect ive procedures for patients with end-stage cardiopulmonary disorders. As ye t, few data exist on the exercise performance of patients before and after thoracic transplantation except with regard to 6-min walk tests. In this ar ticle we report cardiopulmonary exercise test results of lung and heart-lun g transplant recipients in comparison with their pretransplant values. We s tudied 103 consecutive recipients of single-lung (n = 46), bilateral lung ( n = 32), and heart-lung (n = 25) transplants. Cardiopulmonary exercise test ing with a cycle ergometer was performed before and shortly after surgery. Before transplantation, all patients showed severe exercise intolerance and markedly impaired parameters reflecting cardiopulmonary function (e.g., wo rk capacity: 20 +/- 11% predicted; oxygen uptake: 34 +/- 12% predicted; oxy gen pulse: 50 +/- 18% predicted; functional dead space ventilation: 57 +/- 10% of minute ventilation; alveolar-arterial oxygen difference during exerc ise: 79 +/- 15 mm Hg). At 55 +/- 9 d after transplantation, transplant reci pients reached maximum oxygen uptakes in the range of 22 to 71% of predicte d values; the peak oxygen uptake was increased after transplantation (13.1 +/- 3.4 ml/min/kg versus 10.4 +/- 3.8 ml/min/kg; p < 0.001). Work capacity, oxygen pulse, tidal volume, and peak minute ventilation did not differ in patients following single- or double-lung tranplantation or HLT. Ventilator y factors did not appear to limit exercise capacity in any group. Despite t he persistent limitations in aerobic capacity and work rate seen in many of the recipients, cardiopulmonary performance is reasonably well restored sh ortly after LT and HLT.