Near-normal aerobic capacity in long-term survivors after lung transplantation

The aim of this study was to elucidate whether long-term LT survivors with normal spirometry achieve normal exercise capacity, and to identify predictive factors of exercise capacity. This was a cross-sectional multicentre study, where bilateral LT recipients who survived at least 10 years after LT, with normal spirometry, no diagnosis of CLAD and modified Medical Research Council dyspnoea degree ≤2 underwent cardiopulmonary exercise testing (CPET). 28 LT recipients were included with a mean± age of 48.7±13.6 years. Oxygen uptake (V' ) had a mean± value of 21.49±6.68 mL·kg −1 ·min −1 (75.24±15.6%) and the anaerobic threshold was reached at 48.6±10.1% of the V' predicted. The mean± heart rate reserve at peak exercise was 17.56±13.6%. The oxygen pulse increased during exercise and was within normal values at 90.5±19.4%. The respiratory exchange ratio exceeded 1.19 at maximum exercise. The median (25-75 th percentile) EuroQol-5D score was 1 (0.95-1), indicating a good quality of life. The median (25-75 th percentile) International Physical Activity Questionnaire score was 5497 (4007-9832) MET-min·week −1 with 89% of patients reporting more than 1500 MET-min·week −1. In the multivariate regression models, age, sex and diffusing capacity of the lung for carbon monoxide remained significantly associated with V' (mL·kg −1 ·min −1); haemoglobin and forced expiratory volume in 1 s were significantly associated with maximum work rate (watts), after adjusting for confounders. We report for the first time near-normal peak V' values during CPET and normal exercise capacity in long-term LT recipients without CLAD. This is a multicentre study reporting, for the first time, near-normal peak V ' values during cardiopulmonary exercise testing and normal exercise capacity in long-term lung transplant recipients without CLAD