Fuller Louise Mary, Whitford Helen M, Robinson Rebecca, Cristiano Yvie, Steward Ranjana, Poulsen Megan, Paul Eldho, Snell Greg
Physiotherapy Department, The Alfred Hospital, Melbourne, Victoria, Australia.
Respiratory Department, Lung Transplant, The Alfred Hospital, Melbourne, Victoria, Australia.
Clin Transplant. 2024 Jul;38(7):e15393. doi: 10.1111/ctr.15393.
Frailty is prevalent in lung transplant (LTx) candidates, but the impact and subsequent frailty trajectory is unclear. This study aimed to investigate frailty over the first year after LTx.
Post-LTx recipients completed a thrice weekly 12-week directly supervised exercise rehabilitation program. Edmonton Frail Scale (EFS) was used to assess frailty. Primary outcome was 6-Minute Walk Distance (6MWD) measured at pre-LTx, prerehabilitation, postrehabilitation, and 1 year post-LTx.
106 of 139 recruited participants underwent LTx: mean age 58 years, 48% male, 52% with chronic obstructive pulmonary disease. Mean (± SD) frailty scores pre-LTx and 1 year post-LTx were 5.54 ± 2.4 and 3.28 ±1.5. Mean 6MWD improved significantly for all: prerehabilitation 326 m (SD 116), versus postrehabilitation 523 m (SD 101) (p < 0.001) versus 1 year 512 m (SD 120) (p < 0.001). There were significant differences between an EFS > 7 (frail) and EFS ≤ 7 (not frail) for 6MWD, grip strength (GS), anxiety, and depression. Postrehabilitation, there were no significant differences in 6MWD, GS, anxiety, or depression while comparing EFS > 7 versus ≤ 7. At 1 year, there was a significant difference in depression but not 6MWD, GS, or anxiety between those EFS ≤ 7 and > 7 (p = 0.017).
Participants in a structured post-LTx rehabilitation program improved in functional exercise capacity (6MWD), GS, depression, and anxiety. For frail participants exercise capacity, depression, anxiety, and GS were well managed in rehabilitation with no significant differences between those who were not frail. Pre-LTx frailty may be reversible post-LTx and should not be an absolute contraindication to LTx.
衰弱在肺移植（LTx）候选者中很常见，但衰弱的影响及随后的衰弱轨迹尚不清楚。本研究旨在调查肺移植术后第一年的衰弱情况。
肺移植术后受者完成了一项为期12周、每周三次、有直接监督的运动康复计划。采用埃德蒙顿衰弱量表（EFS）评估衰弱情况。主要结局指标是在肺移植术前、康复前、康复后以及肺移植术后1年测量的6分钟步行距离（6MWD）。
139名招募的参与者中有106人接受了肺移植：平均年龄58岁，48%为男性，52%患有慢性阻塞性肺疾病。肺移植术前和术后1年的平均（±标准差）衰弱评分分别为5.54±2.4和3.28±1.5。所有人的平均6MWD均有显著改善：康复前为326米（标准差116），康复后为523米（标准差101）（p<0.001），1年后为512米（标准差120）（p<0.001）。在6MWD、握力（GS）、焦虑和抑郁方面，EFS>7（衰弱）和EFS≤7（非衰弱）之间存在显著差异。康复后，比较EFS>7和≤7时，6MWD、GS、焦虑或抑郁方面无显著差异。在1年时，EFS≤7和>7的参与者在抑郁方面存在显著差异，但在6MWD、GS或焦虑方面无显著差异（p = 0.017）。
参与结构化肺移植术后康复计划的参与者在功能运动能力（6MWD）、GS、抑郁和焦虑方面均有改善。对于衰弱的参与者，运动能力、抑郁、焦虑和GS在康复过程中得到了良好管理，与非衰弱者之间无显著差异。肺移植术前的衰弱在肺移植术后可能是可逆的，不应成为肺移植的绝对禁忌证。
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