Walsh James R, Morris Norman R, Yerkovich Stephanie T, Linnane Matthew P, Chambers Daniel C, Hopkins Peter M A
Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Australia; Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia; School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.
Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia; School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.
J Heart Lung Transplant. 2025 Dec;44(12):1933-1942. doi: 10.1016/j.healun.2025.05.018. Epub 2025 Jun 4.
Defining a transplant candidate's suitable functional status and potential for rehabilitation is complex. Six-minute walk distance (6MWD) criteria are used in candidacy assessment, and pre-transplant quadriceps strength may be a predictor of rehabilitation potential. The study aims were to determine if candidates pre-transplant 6MWD and quadriceps strength are independent factors associated with post-transplant 6MWD and, compare the trajectory in 6MWD and quadriceps strength in candidates from initial assessment to waitlisting and from waitlisting to transplanted (or delisted/died).
An observational repeated measures design was used. 6MWD and QS% were recorded at initial assessment, waitlisting, bi-monthly reassessments until transplanted/delisted/died and 2-, 6- 13- 26- and 52-weeks following transplantation.
342 (192 males; mean (±SD) age 51 ± 14 years; 119 COPD, 93 IIP, 72 cystic fibrosis, and 58 other) were studied. Recipients had a mean increase in 6MWD of 170 ± 127 m (p < 0.001) at 52-weeks post. Weekly 6MWD recovery was greater during the 2- and 6-week period (β 21.73, p < 0.001) compared to the 6- to 52-week period (β 1.28, p < 0.001). In the 2- to 6-weeks after transplantation, greater pre-transplant 6MWD (p < 0.001), stronger pre-transplant QS% (p = 0.001), shorter post-operative hospital admission (p < 0.001) and cystic fibrosis (vs other) were factors associated with a greater 6MWD. In the 6- to 52-weeks after transplantation, stronger QS% value at the corresponding time (p < 0.001), younger recipients (p < 0.001) and greater 2-week post-transplant 6MWD (p < 0.001) were factors associated with a greater 6MWD. Pre-transplant 6MWD decreased by -0.059 m (p < 0.001) and QS% increased by 0.014% (p < 0.001) per day between initial assessment to waitlisting (n = 287).
Pre-transplant 6MWD and quadriceps strength are independent factors associated with recovery in exercise capacity after lung transplantation. However, candidates had a marked deterioration in 6MWD, but quadriceps strength had improved while being worked up for waitlisting. Quadriceps strength, along with 6MWD, should be considered when determining a candidate's lung transplant suitability.
确定移植候选人合适的功能状态和康复潜力很复杂。六分钟步行距离（6MWD）标准用于候选资格评估，移植前的股四头肌力量可能是康复潜力的一个预测指标。本研究的目的是确定移植前候选人的6MWD和股四头肌力量是否是与移植后6MWD相关的独立因素，并比较候选人从初始评估到列入等待名单以及从列入等待名单到移植（或退出等待名单/死亡）期间6MWD和股四头肌力量的变化轨迹。
采用观察性重复测量设计。在初始评估、列入等待名单时、每两个月重新评估直至移植/退出等待名单/死亡以及移植后2周、6周、13周、26周和52周时记录6MWD和股四头肌力量百分比（QS%）。
对342名患者（192名男性；平均（±标准差）年龄51±14岁；119例慢性阻塞性肺疾病（COPD）、93例特发性间质性肺炎（IIP）、72例囊性纤维化和58例其他疾病）进行了研究。移植后52周时，受者的6MWD平均增加了170±127米（p<0.001）。与6至52周期间（β1.28，p<0.001）相比，2至6周期间的每周6MWD恢复更大（β21.73，p<0.001）。在移植后的2至6周内，移植前较高的6MWD（p<0.001）、移植前较强的QS%（p=0.001）、较短的术后住院时间（p<0.001）和囊性纤维化（与其他疾病相比）是与更大的6MWD相关的因素。在移植后的6至52周内，相应时间较强的QS%值（p<0.001）、较年轻的受者（p<0.001）和移植后2周更大的6MWD（p<0.001）是与更大的6MWD相关的因素。从初始评估到列入等待名单（n=287）期间，移植前6MWD每天下降-0.059米（p<0.001），QS%每天增加0.014%（p<0.001）。
移植前的6MWD和股四头肌力量是与肺移植后运动能力恢复相关的独立因素。然而，候选人的6MWD有明显恶化，但在等待列入名单的过程中股四头肌力量有所改善。在确定候选人的肺移植适宜性时，应考虑股四头肌力量以及6MWD。
