Risk factors for the development of interstitial lung disease following severe COVID-19 pneumonia and outcomes of systemic corticosteroid therapy: 3-month follow-up.

BACKGROUND: We aimed to evaluate the pulmonary involvement status, its related factors, and pulmonary function test (PFT) results in the first month follow-up in patients who were discharged for severe Covid-19 pneumonia, and to assess the efficacy of corticosteroid treatment on these parameters in severe pulmonary involvement patients. METHODS: We retrospectively analyzed all consecutive patients who applied to our COVID-19 follow-up clinic at the end of the first month of hospital discharge. Functional and radiological differences were compared after 3 months of corticosteroid treatment in severe pulmonary involvement group. Results We analyzed 391 patients with "pulmonary parenchymal involvement" (PPIG) and 162 patients with "normal lung radiology" (NLRG). 122 patients in the PPIG (corticosteroid-required interstitial lung disease group (CRILD)) had severe pulmonary involvement with frequent symptoms and required corticosteroid prescription. Pulmonary involvement was more common in males and elder patients (P<0.001, for both). Being smoker and elderly were associated with a higher risk-ratio in predicting to be in PPIG (OR:2.250 and OR:1.057, respectively). Smokers, male and elderly patients, and HFNO2 support during hospitalization were risk factors for being a patient with CRILD (OR:2.737, OR:4.937, OR:4.756, and OR:2.872, respectively). After a three-months of methylprednisolone medication, a good response was achieved on radiological findings and PFT results in CRILD. CONCLUSIONS: In conclusion, after severe COVID-19 pneumonia, persistent clinical symptoms and pulmonary parenchymal involvement would be inevitable in elder and smoker patients. Moreover, corticosteroid treatment in patients with severe parenchymal involvement was found to be effective in the improvement of radiological and functional parameters.

A rare case of granulomatosis with polyangiitis with involvement of the gastrointestinal system.

We report a rare case of a 37-year-old man with granulomatosis with polyangiitis (GPA) with gastrointestinal system (GIS) involvement who needed 526 units of blood and blood product transfusions and was followed up in the intensive care unit (ICU). GIS involvement due to GPA is a rare condition that increases morbidity and mortality of patients. Patients may require ultramassive blood product transfusions. Thus, patients with GPA can be admitted to ICUs because of massive hemorrhage due to multisystem involvement, and survival is achievable with meticulous care through a multidisciplinary approach.

The evaluation of disease awareness, caregiver burden, and workday loss in caregivers of COPD patients.

BACKGROUND: Our aim is to determine the caregiver burden of chronic obstructive lung disease (COPD) patient's caregivers, and to determine whether there is a workday loss. METHODS: 252 COPD patients and their caregivers were included. Disease information of the patients were recorded and a questionnaire was applied. Socio-demographic characteristics of the caregivers were recorded and a questionnaire consisting of 24 questions including COPD disease, treatment and loss of working days, and the Zarit Scale were used. RESULTS: 128(50.8%) of the patients according to GOLD were group-D, 97(38.5%) of the patient's relatives were working, 62(24.7%) were not able to go to work for 1-14 days, and 125(57.1%) spent outside the home from 1-14 nights, because those accompanied to patients. In univariate analysis were detected modified medical research council (mMRC) (p < 0.001), CAT (p < 0.001), the number of comorbidities of patients (p = 0.027), forced expiratory volume in 1 FEV1cc (p = 0.009), FEV1% (p < 0.001), the presence of long term oxygen therapy (LTOT), and the number of comorbidities of the patient's relatives (p = 0.06) increased the care load. In multiple linear regression analysis, age (p = 0.03), COPD assessment test (CAT) score (p = 0.001), FEV1% (<0.068) and the number of comorbidities of patients (p = 0.01) and the number of comorbidities of caregivers (p = 0.003) increased the caregiving burden. DISCUSSION: In COPD increases caregiving burden. This burden is greater in symptomatic patients and when comorbidities are present. Psychosocial and legal regulations should be investigated and solutions should be produced for the caregivers of COPD patients.

Comparison of clinical and radiological characteristics of COVID-19 patients with and without pneumothorax and/or pneumediastinum.

Introduction: Pneumothorax (PTX) and pneumomediastinum (PM) are frequently encountered in patients with Coronavirus disease 2019 (COVID-19) and complicate the management of these patients. In this study, we aimed to evaluate the risk factors that cause PTX/PM complications in patients hospitalized due to COVID-19 pneumonia and the effects of these complications on the course of the disease. Materials and Methods: A total of 503 patients with COVID-19 hospitalized in the COVID-19 ward or intensive care unit (ICU) between September 2020 and December 2020 were included in the study. Result: The median age of patients was 65 (min-max, 21-99) years. Of the patients 299 (59.4%) were male and 204 (40.6%) were female. Of the cases, 26 (5.2%) developed PTX or PM. The patients who developed PTX/PM were older than patients who did not [58.5 (min-max, 21-96) vs 65 years (min-max, 22-99), p= 0.029]. The percentage of PTX/PM development was significantly higher in male patients [F/M= 4/22 (2/7.4%) vs 200/277 (98/92.6%), p= 0.007]. Hypertension as a comorbidity was more commonly seen in the group without PTX/PM (p= 0.007). Ground-glass opacity was the most common tomographic finding in both groups, it was significantly higher in those who did not develop PTX/PM (p<0.001). The length of hospital stay was shorter in patients with PTX/PM (p<0.001), but mortality was higher (p= 0.04). Conclusions: PTX/PM were relatively more common in COVID-19 patients. These complications may negatively affect the prognosis of the disease.

Turkish Thoracic Society Early Career Members Task Force Group's Virtual Congress Notes: European Respiratory Society International Congress 2020.

In this article, Early Career Task Force Group members of the Turkish Thoracic Society summarize the European Respiratory Society 2020 virtual congress. Current developments in the field of respiratory diseases were compiled with the addition of sessions specific to coronavirus disease 2019 this year. Almost all of the congress sessions were examined, and the important and striking results of the congress were highlighted. Congress sessions were attended by expert researchers, and the prominent messages of each session were highlighted in short summaries. They were then grouped under relevant titles and ranked in order of meaning and relation. It was finalized by a team of researchers.

Effect of Asbestos Exposure on the Frequency of EGFR Mutations and ALK/ROS1 Rearrangements in Patients With Lung Adenocarcinoma: A Multicentric Study.

OBJECTIVE: The aim of this study is to investigate the effect of asbestos exposure on cancer-driver mutations. METHODS: Between January 2014 and September 2018, epidermal growth factor receptor (EGFR), anaplastic lymphoma receptor tyrosine kinase (ALK), and c-ros oncogene 1 receptor tyrosine kinase gene (ROS1) alterations, demographic characteristics, asbestos exposure, and asbestos-related radiological findings of 1904 patients with lung adenocarcinoma were recorded. RESULTS: The frequencies of EGFR mutations, ALK, and ROS1 rearrangements were 14.5%, 3.7%, and 0.9%, respectively. The rates of EGFR mutations and ALK rearrangements were more frequent in asbestos exposed non-smokers (48.7% and 9%, respectively). EGFR mutation rate was correlated to female gender and not-smoking, ALK rearrangement rate was correlated to younger age, not-smoking, and a history of asbestos exposure. CONCLUSIONS: The higher rate of ALK rearrangements in asbestos-exposed lung adenocarcinoma cases shows that asbestos exposure may most likely cause genetic alterations that drive pulmonary adenocarcinogenesis.

Covid-19: The Biggest Threat of the 21st Century: In Respectful Memory of the Warriors All Over the World.

Since the first case was diagnosed in China, the new coronavirus infection (COVID-19) has become the number one issue in the world and it seems to remain trend-topic for a long time. Until 17 April, it affected 210 countries, infected over 2 million people and caused approximately 150000 deaths. Although the course of the disease ranges from asymptomatic state to severe ARDS; the majority of patients reveal only mild symptoms. Though adults are the most commonly affected group; it can also be seen in newborns and elderly patients. Unfortunately, elderly patients are the most vulnerable group with higher mortality. Elderly patients, smokers and patients with comorbid conditions are most affected by the disease. In certain diagnostical tool is the real-time reverse transcription-polymerase chain reaction (real-time RT-PCR) test. However, it can be resulted in false-negative results and in this case the computed thorax tomography (CT) is one of the most important tools with high sensitivity. Besides the supportive treatment, most commonly used agents are immunomodulatory drugs such as plaquenil and azitromycin, and anti-virals including oseltamivir, ritonavir-lopinavir, favipiravir. Until a vaccine or a specific therapy invented, the most important intervention to control the disease is to fight against transmission. This is a real war and the doctors are the soldiers.

COVID-19 Treatment at a Glance.

As coronavirus disease 2019 (COVID-19) spreads across the world, the ongoing clinical trials are leading to a big race worldwide to develop a treatment that will help control the pandemic. Unfortunately, COVID-19 does not have any known effective treatment with reliable study results yet. In this pandemic, there is not a lot of time to develop a new specific agent because of the rapid spread of the disease. The process of developing a vaccine is long and requires hard work. Although the pathophysiology of the disease is not fully understood, some of the proposed treatment alternatives are based on old evidence and some have been used with the idea that they might work owing to their mechanism of action. The efficacy, reliability, and safety of the currently available treatment alternatives are therefore a matter of debate. Currently, the main therapies used in the treatment of COVID-19 are antiviral drugs and chloroquine/hydroxychloroquine. Other proposed options include tocilizumab, convalescent plasma, and steroids, but the mainstay of the treatment in intensive care units remains supportive therapies.

Unclear Issues Regarding COVID-19.

Scientists from all over the world have been intensively working to discover different aspects of Coronavirus disease 2019 (COVID-19) since the first cluster of cases was reported in China. Herein, we aimed to investigate unclear issues related to transmission and pathogenesis of disease as well as accuracy of diagnostic tests and treatment modalities. A literature search on PubMed, Ovid, and EMBASE databases was conducted, and articles pertinent to identified search terms were extracted. A snow-ball search strategy was followed in order to retrieve additional relevant articles. It was reported that viral spread may occur during the asymptomatic phase of infection, and viral load was suggested to be a useful marker to assess disease severity. In contrast to immune response against viral infections, cytotoxic T lymphocytes decline in SARS-CoV-2 infection, which can be partially explained by direct invasion of T lymphocytes or apoptosis activated by SARS-CoV-2. Dysregulation of the urokinase pathway, cleavage of the SARS-CoV-2 Spike protein by FXa and FIIa, and consumption coagulopathy were the proposed mechanisms of the coagulation dysfunction in COVID-19. False-negative rates of reverse transcriptase polymerase chain reaction varied between 3% and 41% across studies. The probability of the positive test was proposed to decrease with the number of days past from symptom onset. Safety issues related to infection spread limit the use of high flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP) in hypoxic patients. Further studies are required to elucidate the challenging issues, thus enhancing the management of COVID-19 patients.

Lessons Learned so Far from the Pandemic: A Review on Pregnants and Neonates with COVID-19.

There are concerns regarding the risk and the course of COVID-19 in pregnancy and in the neonates. In this review, we aimed to present the current understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and neonatal periods considering diagnosis, treatment, prognosis, and prevention. Few studies on pregnant women with COVID-19 have been conducted between December 2019 and April 2020. The majority of patients applied in the third trimester and presented with fever and cough. Ground-glass opacities and consolidation on computed tomography were reported to be common. COVID-19 was proposed to have a milder course than SARS and the Middle East respiratory syndrome coronavirus in pregnant women. Hydroxychloroquine and antiproteases (lopinavir/ritonavir) were reported to be safe; however, therapeutic efficacy and safety of remdesivir still lack evidence. As ribavirin and favipiravir have teratogenic effects, there are some debates on the use of ribavirin in severe cases. There is still no clear evidence of vertical transmission of SARS-CoV-2 during delivery. Occupational safety issues of pregnant healthcare workers on the frontline should be considered as their risk to develop severe pneumonia is higher because of altered maternal immune response. Knowledge about neonatal outcomes of COVID-19 was based on studies of the last trimester of pregnancy. There is much to be learnt about COVID-19 in pregnant women and in the neonates, especially concerning prognosis- and treatment-related issues.

What We Learned about COVID-19 So Far? Notes from Underground.

The novel coronavirus pandemic poses a major global threat to public health. Our knowledge concerning every aspect of COVID-19 is evolving rapidly, given the increasing data from all over the world. In this narrative review, the Turkish Thoracic Society Early Career Taskforce members aimed to provide a summary on recent literature regarding epidemiology, clinical findings, diagnosis, treatment, prevention, and control of COVID-19. Studies revealed that the genetic sequence of the novel coronavirus showed significant identity to SARS-CoV and MERS-CoV. Angiotensin-converting enzyme 2 receptor is an important target of the SARS-CoV-2 while entering an organism. Smokers were more likely to develop the disease and have a higher risk for ICU admission. The mean incubation period was 6.4 days, whereas asymptomatic transmission was reported up to 25 days after infection. Fever and cough were the most common symptoms, and cardiovascular diseases and hypertension were reported to be the most common comorbidities among patients. Clinical manifestations range from asymptomatic and mild disease to severe acute respiratory distress syndrome. Several patients showed typical symptoms and radiological changes with negative RT-PCR but positive IgG and IgM antibodies. Although radiological findings may vary, bilateral, peripherally distributed, ground-glass opacities were typical of COVID-19. Poor prognosis was associated with older age, higher Sequential Organ Failure Assessment score, and high D-dimer level. Chloroquine was found to be effective in reducing viral replication in vitro. Likewise, protease inhibitors, including lopinavir/ritonavir, favipiravir, and nucleoside analogue remdesivir were proposed to be the potential drug candidates in COVID-19 management. Despite these efforts, we still have much to learn regarding the transmission, treatment, and prevention of COVID-19.

The methods other than spirometry in the early diagnosis of COPD.

Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity around the world. The diagnosis od COPD is based on the presence of clinical symptoms and the fact that the ratio of post-bronhodilator forced expiratory volume in 1 second to forced expiratory vital capacity(FEV1/FVC) is less than 0.70. Persistent limitation of airflow which is a characteristics of COPD is reproducible and most common lung function test that is why it is usually measured by spirometry. The small airway diseases and the parenchymal destruction play a role in the pathogenesis of COPD at different rates over time resulting in chronic airflow limitation. These pathologies are not always together at the same time and the contribution of those to the development of COPD differ from one individual to another. The pathophysiological involvement of small airways in COPD has been confirmed. When the obstruction of the small airways occur either by mucus, smooth muscle hypertrophy, inflammatory infiltration or air wall thickening; then the consequence is the increased resistance and ventilation impairment. The parenchymal destruction can be estimated via scanning and at the initial assessment of a COPD patient, it gives information about the concomitant pulmonary diseases and/or differential diagnosis. There is an increasing interest on symptomatic individuals whose whose COPD diagnosis has not been confirmed yet with spirometry but diagnosis is based on alternative methods and approaches. Although these methods nowadays are commonly used for the clinical research, they will offer an opportunity to the clinician to find out the COPD patients at an early stage. Herein we will discuss the available methods other than spirometry in the early diagnosis of COPD before the overt disease is confirmed.

Diagnostic Analysis of Computed Tomography Patterns in Patients With Invasive Pulmonary Aspergillosis After Solid-Organ Transplantation.

OBJECTIVES: The aim of this study was to assess initial and follow-up computed tomography findings of invasive pulmonary aspergillosis in solid-organ transplant recipients and to examine the most common computed tomography patterns during hospitalization. MATERIALS AND METHODS: From January 2011 to September 2016, the total number of solid-organ transplant patients at our institution was 784. These patients consisted of 550 kidney, 164 liver, and 67 heart transplant recipients. Of these, 15 patients had a proven diagnosis of invasive pulmonary aspergillosis according to clinical and radiologic features with culture evidence of aspergillosis from bronchoalveolar lavage or lung biopsy. Computed tomography examinations were performed at initial diagnosis and at follow-up for evaluation of treatment. Computed tomography patterns were retrospectively evaluated by 2 experienced radiologists. Configurations and types of the largest lesions in each of the 15 patients were evaluated, and changes to lesions during treatment were recorded. Invasive pulmonary aspergillosis patterns were categorized into 6 main groups: ground-glass opacity, nodules, irregular nodules, patchy consolidation, cavity, and tree-in-bud patterns. RESULTS: The most common patterns were ground-glass opacity and irregular nodules, which were observed in 12 of 15 patients (80%), followed by regular nodules (73%), patchy consolidation and cavity (26%), and tree-in-bud pattern (20%). Long-term follow-up computed tomography studies showed that the regular nodules, tree-in-bud patterns, and groundglass opacity areas gradually reduced by 50% in 4 weeks. However, patchy consolidations and irregular nodules showed less regression than the other lesions over the 4-week period. CONCLUSIONS: Irregular nodules and ground-glass opacity were the most common computed tomography patterns in our solid-organ transplant recipients. Computed tomography patterns without irregular nodules and patchy consolidations may be associated with better prognosis due to their relatively rapid healing.

Causes of Hemoptysis in Renal Transplant Patients.

OBJECTIVES: Hemoptysis is a symptom that can be caused by airway disease, pulmonary parenchymal disease, or pulmonary vascular disease, or it can be idiopathic. Infection is the most common cause of hemoptysis, accounting for 60% to 70% of cases. Hemoptysis is also an initial symptom of diffuse alveolar hemorrhage syndrome, although it may be absent at presentation in one-third of patients. Diffuse alveolar hemorrhage is characterized by disruption of the alveolar-capillary basement membranes because of either injury or inflammation of the arterioles, venules, or capillaries, resulting in bleeding in alveolar spaces. To date, no study in the literature has investigated the cause of hemoptysis in renal transplant patients. In this retrospective study, we aimed to investigate the causes of hemoptysis in renal recipients. MATERIALS AND METHODS: The data included in this study were obtained from 352 renal transplant patients who were consulted by the pulmonology department regarding hemoptysis between 2011 and 2017 at Baskent University. Patient medical records were reviewed for demographic, clinical, radiographic, bronchoscopic features, and microbiology data. Immunosuppressive drugs and clinical outcome data were also noted. RESULTS: This study included 352 renal transplant patients (139 male patients with mean age of 34.9 ± 7 years and 113 female patients with mean age of 31.1 ± 5 years). Hemoptysis was detected in 17 patients (4.8%),with 3 (0.85%) having massive hemoptysis as a result of diffuse alveolar hemorrhage syndrome. Fourteen of our patient group (4%) had pneumonia, and Aspergillus species was detected in 5 patients (1.4%). The only reason for diffuse alveolar hemorrhage was immunosuppressive agents, including sirolimus and mycophenolate mofetil. CONCLUSIONS: Hemoptysis is an important respiratory symptom in renal transplant patients. Although community- or hospital-acquired pneumonia may result in hemoptysis, drug-induced diffuse alveolar hemorrhage and Aspergillus infection should be considered for causes in renal transplant patients.

Clinical Characteristics of Acinetobacter baumannii Infection in Solid-Organ Transplant Recipients.

OBJECTIVES: Acinetobacter baumannii, depending on the immune status of the host, may result in one of the most serious hospital infections. Infections involving A. baumannii infection have been recently rising. However, little is known about the clinical features of A. baumannii infection in solid-organ transplant recipients. We aimed to share our clinical experiences with A. baumannii infection in our transplant recipients. MATERIALS AND METHODS: Between 2011 and 2017, 41 solid-organ transplant patients developed A. baumannii infection at Baskent University Hospital. Medical records were reviewed, and patient demographics, microbiology results, and overall outcome data were noted. RESULTS: Of 41 solid-organ transplant patients with A. baumannii infection, 29 were male and 12 were female patients with mean age of 47.15 ± 13.24 years. Our infection rate with A. baumannii infection was 6.1%. The most common sites of infection were deep tracheal aspirate (48.8%)and bloodstream (36.6%). Onset of infection 1 year posttransplant was identified in 58.5% of recipients. Risk factors included presence of invasive procedures (56.1%) and administration of high-dose corticosteroids for rejection 1 year before infection (68.3%). Thirty-day mortality rate was 41.5% (17/41 patients) and was not associated with the infection site, microbiological cure, clinical cure, and drug resistance in our study group. CONCLUSIONS: Acinetobacter baumannii is an important cause of hospital-acquired infection and mortality worldwide. A major problem with A. baumannii infection is delayed initiation of appropriate antibiotic treatment and the rising numbers of extensively drug-resistant organisms. Predicting the potential risk factors, especially in the already at-risk solid-organ transplant population, has an important role in patient outcomes.

Radiologically Occult Invasive Pulmonary Aspergillosis in a Patient With Liver Transplant.

Invasive pulmonary aspergillosis is an infection seen in patients receiving intensive immunosuppressive regimens, such as transplant recipients. Some risk factors that increase the incidence of infection have been determined, and patients defined as having high risk are recommended to take antifungal prophylaxis and be monitored closely. Here, we present a liver transplant patient with mild respiratory symptoms and a normal chest radiography on day 26 posttransplant. However, he had acute renal failure and underwent hemodialysis, which are both defined to increase significantly the risk of aspergillosis. Although the radiographic scan was initially normal, thorax tomography and later bronchoscopy showed findings compatible with pulmonary aspergillosis, and the patient was started on antifungal treatment. The nonspecific mild symptoms and an initial normal radiology can make diagnosis of invasive fungal infections difficult; thus caution and close follow-up of high-risk patients should be performed.

Utility of Mean Platelet Volume to Diagnose Pneumonia in Patients With Solid-Organ Transplant.

OBJECTIVES: Despite improved success with solid-organ transplant procedures, recipients remain at risk for infections, including pneumonia, due to their immunosuppressive regimens. In solid-organ transplant patients, clinical findings of pneumonia can be nonspecific, and diagnosis of pneumonia may be difficult as several conditions (drug lung, hypervolemia, infections, hemorrhage) can led to pulmonary infiltrates, mimicking pneumonia in these patients. The role of mean platelet volume, a predictor of inflammatory disease, with elevated values inversely correlated with inflammatory problems, in the diagnosis of pneumonia has not yet been investigated in solid-organ transplant patients. Here, we retrospectively investigated mean platelet volume in diagnosis of pneumonia in transplant patients. MATERIALS AND METHODS: Medical records of solid-organ transplant patients from 2011 to 2016 were reviewed for demographic, clinical, radiographic, laboratory, and microbiology data. Transplant type, immunosuppressive drugs, and clinical outcomes were noted. Pneumonia diagnosis was based on clinical respiratory symptoms and signs, imaging findings, positive microbiological tests, pathologic findings, laboratory findings, or effective clinical treatment trials. RESULTS: Our study included 70 patients (47 male/23 female; mean age of 46 ± 14 years), comprising 26 liver and 44 renal transplant recipients. Pneumonia was diagnosed radiologically in 30 patients (42.9%), with procalcitonin positive in 11 patients (36.7%), C-reactive protein elevated in 29 patients (96.7%), and leukocytes increased in 6 patients (20%). When laboratory measurements were compared with mean platelet volume, mean platelet volume values were significantly lower in patients with pneumonia who had elevated procalcitonin levels (P = .038). CONCLUSIONS: We found that mean platelet volume for diagnosis of pneumonia in solid-organ transplant patients was not a promising tool. Considering the difficulties in caring for transplant patients with pulmonary infiltrates, clinical decisions should be based on clinical, laboratory, microbiological, and radiologic findings.

Peripheral Muscle Strength Indicates Respiratory Function Testing in Renal Recipients.

OBJECTIVES: Muscle wasting occurs in renal recipients due to decreased physical performance, and decreased respiratory muscle strength may occur due to changes in structure and function. Data are scarce regarding the roles of sarcopenia and nutritional status on respiratory muscle function in these patients. Here, we evaluated interactions among peripheral muscle strength, sarcopenia, nutritional parameters, and respiratory muscle function in renal transplant recipients. MATERIALS AND METHODS: Ninety-nine patients were prospectively enrolled between September and April 2016 at Baskent University. Forced vital capacity values (via pulmonary function tests), respiratory muscle strength (via maximal static inspiratory and expiratory pressures), and peripheral muscle strength (via hand grip strength test) were recorded. Nutritional parameters, fat weight, arm circumference, waist circumference, and C-reactive protein levels were also recorded. RESULTS: Of 99 patients, 68 were renal transplant recipients (43 men, mean age: 39.09 ± 10.70 y) and 31 were healthy participants (14 men, mean age: 34.94 ± 10.95 y). Forced vital capacity (P < .001, r = 0.65), maximal inspiratory (P = .002, r = 0.39) and expiratory (P < .001, r = 0.4) pressure, and hand grip strength showed significant relations in transplant recipients. Positive correlations were found between serum albumin levels and both hand grip strength (P = .16, r = 0.347) and forced vital capacity (P = .03, r = 0.436). Forced vital capacity was statistically different between renal recipients and healthy participants (P = .013), whereas maximal inspiratory and expiratory pressures were not (P > .05). No statistically significant relation was observed between biochemical parameters and maximal inspiratory and expiratory pressures (P ? .05). CONCLUSIONS: Respiratory function and peripheral muscle strength were significantly related in renal transplant recipients, with significantly lower peripheral muscle strength suggesting the presence of inadequate respiratory function. Peripheral and respiratory muscle training and nutritional replacement strategies could help to improve postoperative respiratory function.