Background
Pulmonary function tests (PFT) are a frequent component of heart transplant evaluation.
In cardiac surgery abnormal PFTs, especially reduced DLCO, have been associated with
poor outcomes. We sought to evaluate the impact of pretransplant PFTs on post-transplant
pulmonary outcomes and patient survival.
Methods
Among the 652 adult heart transplant recipients between January 1, 2010 and July 31,
2021, 462 had PFTs and constituted the patient cohort. Obstructive ventilatory defects
(OVD), restrictive ventilatory defects (RVD), and reduced DLCO were defined according
to established criteria. The primary outcome was the combined endpoint of a post-transplant
pulmonary complication defined as reintubation, postoperative pneumonia, prolonged
intubation, or tracheostomy. Secondary outcomes included 90-day all-cause mortality,
length of stay, and the odds of individual pulmonary complications. Kaplan–Meier survival
analysis, multivariable Cox proportional-hazards regression, and multivariable logistic
regression were performed to compare outcomes between the groups.
Results
Patients with severe OVD (OR 1.48, 95% CI 1.18-5.23, p = 0.02) or severely reduced DLCO (OR 1.95, 95% CI 1.19-3.20, p = 0.008) had increased odds of post-transplant pulmonary complications. Following
multivariable adjustment, severe OVD (aOR 2.67, 95% CI 1.15-6.19, p = 0.02) and severely reduced DLCO (aOR 1.79, 95% CI 1.05-3.04) remained strongly
associated with post-transplant pulmonary complications. Patients with any degree
of extrinsic RVD, moderate or less OVD, or moderately reduced DLCO or less did not
have increased odds of post-transplant pulmonary complications. Ninety-day post-transplant
survival was significantly reduced for both severe OVD (97.2% vs 86.5%, p = 0.04) and severely reduced DLCO (97.3% vs 90.4%, p = 0.004). Post-transplant ICU and hospital length of stay were nominally longer for
both groups as well.
Conclusions
Severe OVD or severely reduced DLCO on preheart transplant PFTs were associated with
increased odds of post-transplant pulmonary complications and early mortality.
Keywords
Abbreviations:
DLCO (diffusion capacity for carbon monoxide), FEV1 (forced expiratory volume in 1 second), FVC (forced vital capacity), OVD (obstructive ventilatory defects), PFT (pulmonary function test), RVD (restrictive ventilatory defect)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 28, 2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 International Society for Heart and Lung Transplantation. All rights reserved.
