Ventilatory and diffusion abnormalities in long-term survivors after orthotopic heart transplantation.
OBJECTIVE
To investigate the long-term development of pulmonary diffusion abnormalities after orthotopic heart transplantation (oHT).


METHODS
Retrospective analysis of pulmonary function test results of different patient groups at different time intervals after oHT was performed.


METHODS
This investigation included 642 patients who had undergone oHT for chronic heart failure. Patients were grouped according to the time elapsed after transplantation (group 1: n = 164; age, 47 +/- 14 years; days after oHT, 324 +/- 101; group 2: n = 100; age, 48 +/- 15 years; days after oHT, 723 +/- 104; group 3: n = 106; age, 52 +/- 12 years; days after oHT, 1,092 +/- 98; group 4: n = 84; age, 51 +/- 13 years; days after oHT, 1,442 +/- 99; group 5: n = 61; age, 50 +/- 14 years; days after oHT, 1,819 +/- 105; group 6: n = 101; age, 53 +/- 12 years; days after oHT, 2,463 +/- 303; and group 7: n = 26; age, 54 +/- 14 years; days after oHT, 3,478 +/- 246). In 56 (group 8) of the 642 patients, follow-up measurements were performed with tests before and at two time points after oHT (6.5 +/- 1.7 and 12.5 +/- 9.3 months).


RESULTS
Of all patients, 39% showed restrictive and obstructive abnormalities with no differences between the groups. No significant differences in lung transfer factor for carbon monoxide (DLCO) were observed (61.2 vs 63.7 vs 65.5 vs 65.6 vs 64.5 vs 65.7 vs 67.6% predicted). Differences in transfer coefficient for carbon monoxide (Kco) were significant between group 1 and 4 (58.7 vs 64.1% predicted), and group 1 and 6 (58.7 vs 63.4% predicted). No differences occurred in the rate with which patients exhibited pathologic abnormalities for DLCO and KCO. After oHT, a marked reduction in diffusion capacity occurred in group 8. On follow-up, these measurements were only slightly restored in terms of the predicted DLCO percentage. No such improvement was observed in KCO or in the rate of pathologic changes for both DLCO and KCO. We conclude, therefore, that the impairment of diffusion does not improve even after a significant period has passed after the oHT. Whether this has any effect on symptoms and/or the prognosis for these patients is extremely unclear.
Ewert
R
R
Deutsches Herzzentrum, Berlin, Germany.
Wensel
R
R
Bettmann
M
M
Spiegelsberger
S
S
Grauhan
O
O
Hummel
M
M
Hetzer
R
R
D002248:Carbon Monoxide / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011659:Pulmonary Gas Exchange; D012115:Residual Volume; D015656:Respiratory Mechanics; D012189:Retrospective Studies; D014109:Total Lung Capacity; D014797:Vital Capacity
D002248:Carbon Monoxide