Saez-Gimenez Berta, Barrecheguren Miriam, Ramon Maria Antònia, Gomez-Garrido Alba, Bravo Carlos, Monforte Víctor, López-Meseguer Manuel, Berastegui Cristina, Revilla Eva, Romero Christian, Laporta Rosalía, Fernández-Rozas Sonia, Redel-Montero Javier, Solé Amparo, de la Torre Mercedes, Puente Luis, Roman Antonio, Gómez-Ollés Susana, Ojanguren Iñigo
Servicio de Neumología, Hospital Universitari Vall d'Hebron, Departamento de Medicina, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain.
These authors contributed equally.
ERJ Open Res. 2021 Feb 1;7(1). doi: 10.1183/23120541.00381-2020. eCollection 2021 Jan.
The clinical course of lung transplantation (LT) is diverse: some patients present chronic lung allograft dysfunction (CLAD) and progressive decline in pulmonary function, but others maintain normal spirometric values and active lives.
The aim of this study was to elucidate whether long-term LT survivors with normal spirometry achieve normal exercise capacity, and to identify predictive factors of exercise capacity.
This was a cross-sectional multicentre study, where bilateral LT recipients who survived at least 10 years after LT, with normal spirometry, no diagnosis of CLAD and modified Medical Research Council dyspnoea degree ≤2 underwent cardiopulmonary exercise testing (CPET).
28 LT recipients were included with a mean±sd age of 48.7±13.6 years. Oxygen uptake ( ) had a mean±sd value of 21.49±6.68 mL·kg·min (75.24±15.6%) and the anaerobic threshold was reached at 48.6±10.1% of the predicted. The mean±sd heart rate reserve at peak exercise was 17.56±13.6%. The oxygen pulse increased during exercise and was within normal values at 90.5±19.4%. The respiratory exchange ratio exceeded 1.19 at maximum exercise. The median (25-75 percentile) EuroQol-5D score was 1 (0.95-1), indicating a good quality of life. The median (25-75 percentile) International Physical Activity Questionnaire score was 5497 (4007-9832) MET-min·week with 89% of patients reporting more than 1500 MET-min·week. In the multivariate regression models, age, sex and diffusing capacity of the lung for carbon monoxide remained significantly associated with (mL·kg·min); haemoglobin and forced expiratory volume in 1 s were significantly associated with maximum work rate (watts), after adjusting for confounders.
We report for the first time near-normal peak values during CPET and normal exercise capacity in long-term LT recipients without CLAD.
肺移植（LT）的临床病程多种多样：一些患者出现慢性肺移植功能障碍（CLAD）且肺功能逐渐下降，但另一些患者肺活量测定值正常且生活积极。
本研究旨在阐明肺活量测定正常的长期LT存活者是否具有正常的运动能力，并确定运动能力的预测因素。
这是一项横断面多中心研究，纳入了LT术后至少存活10年、肺活量测定正常、未诊断为CLAD且改良医学研究委员会呼吸困难程度≤2级的双侧LT受者，进行心肺运动试验（CPET）。
纳入28例LT受者，平均±标准差年龄为48.7±13.6岁。摄氧量（ ）的平均±标准差为21.49±6.68 mL·kg·min（75.24±15.6%），无氧阈在预测值的48.6±10.1%时达到。运动峰值时平均±标准差心率储备为17.56±13.6%。运动期间氧脉搏增加，在90.5±19.4%时处于正常范围内。最大运动时呼吸交换率超过1.19。欧洲五维健康量表（EuroQol-5D）评分中位数（第25 - 75百分位数）为1（0.95 - 1），表明生活质量良好。国际体力活动问卷评分中位数（第25 - 75百分位数）为5497（4007 - 9832）MET - min·周，89%的患者报告超过1500 MET - min·周。在多变量回归模型中，校正混杂因素后，年龄、性别和肺一氧化碳弥散量仍与摄氧量（mL·kg·min）显著相关；血红蛋白和第1秒用力呼气量与最大工作率（瓦特）显著相关。
我们首次报告了无CLAD的长期LT受者在CPET期间接近正常的峰值摄氧量和正常的运动能力。
