title: Evaluation of pulmonary function and exercise performance by cardiopulmonary exercise testing before and after lung transplantation.
abstract: BACKGROUND
  Detailed description of functional exercise outcomes before and after lung transplantation is lacking. The objective of this study was to describe and compare posttransplant improvement in lung function and peak exercise parameters in patients with advanced lung disease.
  
  
  METHODS
  The study included 153 patients who underwent lung transplantation over 7 years who had complete cardiopulmonary exercise testing (CPET) and pulmonary function tests (PFTs) before and after lung transplantation. CPET and PFT within 30 months pretransplant and posttransplant were compared.
  
  
  RESULTS
  Pulmonary function markedly improved posttransplant as FVC increased 67%, maximum voluntary ventilation increased 91%, and FEV(1) increased 136%. However, peak oxygen consumption increased only 19%, peak CO(2) production increased 50%, and peak work increased 78%. Although transplant recipients had a 1.5- to 2.0-fold increase in exercise capacity posttransplant, peak exercise capacity remained at 50% of the predicted normal, suggesting a maximal limitation. Subgroup stratification into quartiles based on pretransplant exercise capacity revealed the greatest exercise benefit to be in the lowest functional pretransplant groups.
  
  
  CONCLUSIONS
  Lung transplant recipients have an increase in exercise capacity that does not match the improvement in lung function, indicating that poor strength, deconditioning, or other peripheral factors play a significant role in the limitation of exercise benefit posttransplantation. Further elucidation of the mechanisms of exercise limitation may allow for improved exercise outcomes posttransplant.
authors.affiliation: Department of Rehabilitation and Regenerative Medicine, College of Physicians and Surgeons, Columbia University New York, NY. Electronic address: mnb4@columbia.edu.
authors.forename: Matthew N
authors.initials: MN
authors.lastname: Bartels
authors.affiliation: Department of Rehabilitation and Regenerative Medicine, College of Physicians and Surgeons, Columbia University New York, NY.
authors.forename: Hilary F
authors.initials: HF
authors.lastname: Armstrong
authors.affiliation: Department of Rehabilitation and Regenerative Medicine, College of Physicians and Surgeons, Columbia University New York, NY.
authors.forename: Renee E
authors.initials: RE
authors.lastname: Gerardo
authors.affiliation: Department of Surgery, Columbia University New York, NY.
authors.forename: Aimee M
authors.initials: AM
authors.lastname: Layton
authors.affiliation: Department of Psychology, Boston University, Boston, MA.
authors.forename: Benjamin O
authors.initials: BO
authors.lastname: Emmert-Aronson
authors.affiliation: Department of Surgery, Columbia University New York, NY.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Sonett
authors.affiliation: Department of Medicine, Columbia University New York, NY.
authors.forename: Selim M
authors.initials: SM
authors.lastname: Arcasoy
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005080:Exercise Test / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010807:Physical Endurance / Q000502:physiology; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome