Value of exercise testing to estimate post-operative complications and mortality in solid organ recipients: a preliminary study.
BACKGROUND
The pre-operative pulmonary risk assessment of solid organ transplant recipients is crucial to decrease post-operative pulmonary mortality and morbidity. Spirometry is the most commonly utilized test to predict post-operative pulmonary complications. This study was performed to evaluate the role of Cardiopulmonary Exercise Testing (CPET) in both heart and kidney transplantation recipients.


METHODS
Patients referred for pulmonary evaluation between August 2008 and June 2009 prior to solid organ transplantation were included in this study. Patients' history, demographics, and physical examination were recorded. All patients performed pulmonary function tests (PFTs) and symptom-limited CPET. Thirty-four subjects (21 with heart failure and 16 with chronic renal failure) awaiting solid organ transplantation were enrolled to this study prospectively.


RESULTS
No pulmonary complication was found in the renal transplantation recipients, and there were pulmonary complications in 10 heart transplantation recipients. There was no difference between spirometric parameters with post-operative early pulmonary complications and mortality (p>0.05) in heart and kidney transplantation recipients. Anaerobic threshold oxygen uptake (VO(2)@AT) was significantly decreased, while minute ventilation to carbon dioxide output (VE/VCO(2)@AT) was increased in heart recipients (p<0.05).


CONCLUSIONS
CPET parameters measured at anaerobic threshold could help predict surgical mortality and pulmonary complications following heart transplantation. However, our study demonstrated that CPET parameters could not predict post-operative mortality and pulmonary complications in renal recipients. Therefore, heart transplant candidates should be routinely evaluated with CPET and spirometry to estimate post-operative early mortality and pulmonary complications pre-operatively.
Ulubay
Gaye
G
Department of Pulmonary Diseases, Baskent University School of Medicine, Ankara, Turkey. gayeulubay@yahoo.com
Ulasli
Sevinc
S
Küpeli
Elif
E
Yilmaz
Eylul
E
Sezgin
Atilla
A
Haberal
Mehmet
M
D000328:Adult; D005080:Exercise Test; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000502:physiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000502:physiology; D008171:Lung Diseases / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013147:Spirometry; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult