Pulmonary rehabilitation improves survival in patients with idiopathic pulmonary fibrosis undergoing lung transplantation

Juliessa Florian, Guilherme Watte, Paulo José Zimermann Teixeira, Stephan Altmayer, Sadi Marcelo Schio, Letícia Beatriz Sanchez, Douglas Zaione Nascimento, Spencer Marcantonio Camargo, Fabiola Adélia Perin, José de Jesus Camargo, José Carlos Felicetti, José da Silva Moreira, Juliessa Florian, Guilherme Watte, Paulo José Zimermann Teixeira, Stephan Altmayer, Sadi Marcelo Schio, Letícia Beatriz Sanchez, Douglas Zaione Nascimento, Spencer Marcantonio Camargo, Fabiola Adélia Perin, José de Jesus Camargo, José Carlos Felicetti, José da Silva Moreira

Abstract

This study was conducted to evaluate whether a pulmonary rehabilitation program (PRP) is independently associated with survival in patients with idiopathic pulmonary fibrosis (IPF) undergoing lung transplant (LTx). This quasi-experimental study included 89 patients who underwent LTx due to IPF. Thirty-two completed all 36 sessions in a PRP while on the waiting list for LTx (PRP group), and 53 completed fewer than 36 sessions (controls). Survival after LTx was the main outcome; invasive mechanical ventilation (IMV), length of stay (LOS) in intensive care unit (ICU) and in hospital were secondary outcomes. Kaplan-Meier curves and Cox regression models were used in survival analyses. Cox regression models showed that the PRP group had a reduced 54.0% (hazard ratio = 0.464, 95% confidence interval 0.222-0.970, p = 0.041) risk of death. A lower number of patients in the PRP group required IMV for more than 24 hours after LTx (9.0% vs. 41.6% p = 0.001). This group also spent a mean of 5 days less in the ICU (p = 0.004) and 5 days less in hospital (p = 0.046). In conclusion, PRP PRP completion halved the risk of cumulative mortality in patients with IPF undergoing unilateral LTx.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flowchart of the study. LTx: lung transplantation; ECMO: extracorporeal membrane oxygenation; IPF: idiopathic pulmonary fibrosis; PRP: pulmonary rehabilitation program.
Figure 2
Figure 2
Kaplan-Meier curves of cumulative survival of patients stratified by PRP status after lung transplantation. PRP = pulmonary rehabilitation program.

References

    1. Raghu Ganesh. Idiopathic pulmonary fibrosis: lessons from clinical trials over the past 25 years. European Respiratory Journal. 2017;50(4):1701209. doi: 10.1183/13993003.01209-2017.
    1. Raghu G, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am. J. Respir. Crit. Care Med. 2011;183:788–824. doi: 10.1164/rccm.2009-040GL.
    1. Caminati Antonella, Cassandro Roberto, Torre Olga, Harari Sergio. Severe idiopathic pulmonary fibrosis: what can be done? European Respiratory Review. 2017;26(145):170047. doi: 10.1183/16000617.0047-2017.
    1. Dowman, L., Hill, C. J. & Holland, A. E. Pulmonary rehabilitation for interstitial lung disease. Cochrane Database of Systematic Reviews (2014).
    1. Dowman LM, et al. The evidence of benefits of exercise training in interstitial lung disease: a randomised controlled trial. Thorax. 2017;72:610–619. doi: 10.1136/thoraxjnl-2016-208638.
    1. Wickerson L, et al. Physical rehabilitation for lung transplant candidates and recipients: An evidence-informed clinical approach. World J. Transplant. 2016;6:517–531. doi: 10.5500/wjt.v6.i3.517.
    1. Li M, Mathur S, Chowdhury NA, Helm D, Singer LG. Pulmonary rehabilitation in lung transplant candidates. J. Heart Lung Transplant. 2013;32(6):626–632. doi: 10.1016/j.healun.2013.04.002.
    1. Gloeckl R, Halle M, Kenn K. (2012). Interval versus continuous training in lung transplant candidates: a randomized trial. J. Heart Lung Transplant. 2012;31:934–941. doi: 10.1016/j.healun.2012.06.004.
    1. Banga A, et al. Hospital length of stay after lung transplantation: Independent predictors and association with early and late survival. J. Heart Lung Transplant. 2016;36:289–296. doi: 10.1016/j.healun.2016.07.020.
    1. Orens JB, et al. International guidelines for the selection of lung transplant candidates: 2006 update–a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J. Heart Lung Transplant. 2006;25:745–755. doi: 10.1016/j.healun.2006.03.011.
    1. Floreth, T. & Bhorade, S. M. Current trends in immunosuppression for lung transplantation. Semin. Respir. Crit. Care Med. 31, 172–178 (2).
    1. Monforte Victor, Sintes Helena, López-Gallo Cristina, Delgado Maria, Santos Francisco, Zurbano Felipe, Solé Amparo, Gavaldá Joan, Borro Jose Maria, Redel-Montero Javier, Cifrian Jose Manuel, Pastor Amparo, Román Antonio, Ussetti Piedad. Risk factors, survival, and impact of prophylaxis length in cytomegalovirus-seropositive lung transplant recipients: A prospective, observational, multicenter study. Transplant Infectious Disease. 2017;19(3):e12694. doi: 10.1111/tid.12694.
    1. Neoh CF, et al. Antifungal prophylaxis in lung transplantation. Int. J. Antimicrob. Agents. 2014;44(3):194–202. doi: 10.1016/j.ijantimicag.2014.05.013.
    1. Pellegrino R, et al. Interpretative strategies for lung function tests. Eur. Respir. J. 2005;26:948–968. doi: 10.1183/09031936.05.00035205.
    1. American Thoracic Society, European Respiratory Society. American Thoracic Society/European Respiratory Society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. Am. J. Respir. Crit. Care Med. 2002;165:277–304. doi: 10.1164/ajrccm.165.2.ats01.
    1. Pereira CA, Sato T, Rodrigues SC. New reference values for forced spirometry in white adults in Brazil. J. Bras. Pneumol. 2007;33:397–406. doi: 10.1590/S1806-37132007000400008.
    1. American Thoracic Society. ATS statement: guidelines for the six-minute walk test. Am. J. Respir. Crit. Care Med. 2002;166:111–117. doi: 10.1164/ajrccm.166.1.at1102.
    1. Campolina AG, Ciconelli RM. [SF-36 and the development of new assessment tools for quality of life] Acta Reumatol. Port. 2008;33:127–133.
    1. Dierich M, et al. The influence of clinical course after lung transplantation on rehabilitation success. Transpl. Int. 2013;26:322–330. doi: 10.1111/tri.12048.
    1. Komatsu T, et al. Physical activity level significantly affects the survival of patients with end-stage lung disease on a waiting list for lung transplantation. Surg. Today. 2017;47:1526–1532. doi: 10.1007/s00595-017-1542-6.
    1. Banga A, et al. Hospital length of stay after lung transplantation: Independent predictors and association with early and late survival. J. Heart Lung Transplant. 2017;36:289–296. doi: 10.1016/j.healun.2016.07.020.
    1. Florian J, et al. Impact of pulmonary rehabilitation on quality of life and functional capacity in patients on waiting lists for lung transplantation. J. Bras. Pneumol. 2013;39:349–356. doi: 10.1590/S1806-37132013000300012.
    1. Arango Tomás EA, Algar FJ, Cerezo Madueño F, Salvatierra Velázquez A. Evolution and Risk Factors for Early Mortality After Lung Transplantation for Idiopathic Pulmonary Fibrosis: An Experience of 20 Years. Transplantation Proceedings. 2015;47:2656–2658. doi: 10.1016/j.transproceed.2015.09.048.
    1. Sheikh SI, Hayes D, Kirkby SE, Tobias JD, Tumin D. Age-dependent Gender Disparities in Post Lung Transplant Survival Among Patients With Idiopathic Pulmonary Fibrosis. Ann. Thorac. Surg. 2017;103:441–446. doi: 10.1016/j.athoracsur.2016.08.083.
    1. Rubin AS, et al. Functional improvement in patients with idiopathic pulmonary fibrosis undergoing single lung transplantation. J. Bras. Pneumol. 2015;41:299–304. doi: 10.1590/S1806-37132015000000057.
    1. Christie JD, et al. The Registry of the International Society for Heart and Lung Transplantation Twenty-sixth Official Adult Lung and Heart-Lung Transplantation Report-2009. J. Heart Lung Transplant. 2009;28:1031–1049. doi: 10.1016/j.healun.2009.08.004.

Source: PubMed

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