Reproducibility of the 6-minute walk test in lung transplant recipients.

PURPOSE: There is reason to believe that the favorable measurement properties of the 6­minute walk test (6MWT) reported for retest reliability and its capability to detect a true change in healthy individuals or persons with chronic respiratory disease may not apply to lung transplant recipients (LuTXr). We therefore investigated retest reliability of the 6MWT and, in addition, made an attempt to explore whether the 6MWT was sensitive enough to detect important changes that occur with postacute rehabilitation in LuTXr after first time LuTX. METHODS: Immediately before postacute rehabilitation, 50 LuTXr completed 6MWT testing twice, separated by 1-2 workdays (retest reliability), and were reassessed after completion of rehabilitation 2 months later (sensitivity to changes). Body function measures and health-related quality of life (HRQoL) assessments were collected at baseline. RESULTS: Baseline retest 6­minute walk distance (6MWD) and the age-related predicted walking distance (6MWD%pred) scores significantly increased before postacute rehabilitation. The intraclass coefficient of correlation ICC of the 6MWD was 0.93 (95% confidence interval, CI: 0.88-0.96) and its smallest real difference (SRD) 79 m (95% CI: 52;107). Receiver operating curve analyses revealed the rehabilitation associated changes in 6MWD/6MWD%pred to exceed the SRD/SRD% values in a highly accurate way. CONCLUSION: The 6MWT overall represents a reliable functional performance tool in LuTXr that is sensitive to detect changes in physical performance as a result of medical postacute rehabilitation.

Clinical relevance of lung transplantation for COVID-19 ARDS: a nationwide study.

BACKGROUND: Although the number of lung transplantations (LTx) performed worldwide for COVID-19 induced acute respiratory distress syndrome (ARDS) is still low, there is general agreement that this treatment can save a subgroup of most severly ill patients with irreversible lung damage. However, the true proportion of patients eligible for LTx, the overall outcome and the impact of LTx to the pandemic are unknown. METHODS: A retrospective analysis was performed using a nationwide registry of hospitalised patients with confirmed severe acute respiratory syndrome coronavirus type 2 (SARS-Cov-2) infection admitted between January 1, 2020 and May 30, 2021 in Austria. Patients referred to one of the two Austrian LTx centers were analyzed and grouped into patients accepted and rejected for LTx. Detailed outcome analysis was performed for all patients who received a LTx for post-COVID-19 ARDS and compared to patients who underwent LTx for other indications. RESULTS: Between January 1, 2020 and May 30, 2021, 39.485 patients were hospitalised for COVID-19 in Austria. 2323 required mechanical ventilation, 183 received extra-corporeal membrane oxygenation (ECMO) support. 106 patients with severe COVID-19 ARDS were referred for LTx. Of these, 19 (18%) underwent LTx. 30-day mortality after LTx was 0% for COVID-19 ARDS transplant recipients. With a median follow-up of 134 (47-450) days, 14/19 patients are alive. CONCLUSIONS: Early referral of ECMO patients to a LTx center is pivotal in order to select patients eligible for LTx. Transplantation offers excellent midterm outcomes and should be incorporated in the treatment algorithm of post-COVID-19 ARDS.

Lung transplantation in patients with incidental early stage lung cancer-institutional experience of a high volume center.

BACKGROUND: Incidentally discovered lung cancers in lung transplant (LuTX) recipients are rare but may affect outcome. We aim to report our single center experience with incidence, management, and survival of patients with previously unverified primary lung cancer discovered at the time of LuTX. METHODS: A total of 1262 patients undergoing LuTX between 1989 and 2012 were retrospectively analyzed in our prospective database. RESULTS: Patients identified were six men and five women with a mean age of 54.4±9.9 years. The indication for LuTX was COPD (n=9), pulmonary fibrosis (n=1), and cystic fibrosis (n=1). Histological diagnosis of the explanted lung revealed adenocarcinoma in six, squamous cell carcinoma in three, and lepidic predominant adenocarcinoma in two cases, respectively. Staging revealed stage IA (pT1a/b pN0) in eight and IB (pT2a pN0) in two cases and one patient in stage IIA (pT1b pN1). Subsequent cancer staging after LuTX revealed no metastasis. Immunosuppression was adjusted and no adjuvant chemo- or radiotherapy was administered. The 5-year survival rate was 90.5% with no detection of recurrence. CONCLUSION: In patients with incidentally detected early stage lung cancer at the time of LuTX, rates of recurrence and survival based on this sample appear to be acceptable.

A rare indication for lung transplantation - pulmonary alveolar microlithiasis: institutional experience of five consecutive cases.

BACKGROUND: Pulmonary alveolar microlithiasis (PAM) is a rare lung disease caused by calcifications within the alveolar space. The only known effective treatment for an end-stage PAM is lung transplantation (LuTX). METHODS: We performed a retrospective chart review of all individuals that underwent lung transplantation at our center between 1989 and 2013. Five consecutive patients with PAM were identified. RESULTS: Four females and one male with a mean age of 46.3 yr were identified. Extracorporeal membrane oxygenation (ECMO) support was required intraoperatively in four cases and post-operatively in one case. Mean post-operative intubation time was 3.3 (range, 2-5) d and mean intensive care unit (ICU) stay was 8.3 (range, 4-12) d. No intraoperative complications were observed. One early patient (operated in 1995) underwent acute re-transplantation on the second post-operative day (POD) and died from sepsis on the 11 POD. In one patient reperfusion edema was observed requiring a prolonged weaning process. No other severe perioperative complications were observed. Four of five patients are currently still alive with normal follow-up parameters. No recurrence of PAM was observed. CONCLUSIONS: Lung transplantation is a feasible therapy option in patients with end-stage PAM showing good post-operative results comparable to other indications for LuTX.