Nobuyoshi MORI, Yoko GOTO, Hajime KUROSAWA, Kayomi MATSUMOTO, Kazunori YOSHIDA, Naoyoshi MINAMI, Masayuki KANAZAWA, Masahiro KOHZUKI

Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine

(Received 25 September 2002; accepted 11 April 2003)

Abstract: Lung transplantation (LT) has been successfully performed worldwide in patients with end-stage lung diseases, and pulmonary rehabilitation plays an important role in this treatment. Since the first LT from a brain-death donor was performed in March 2000, 11 LT from 9 donors were performed in Japan. Of these, 4 patients (3 cases were unilateral LT, 1 was bilateral) were operated on in our institute, one of only 4 official centers for performing lung transplants in Japan. We experienced pulmonary rehabilitation before and after the operations, and this report aimed to access the effects of rehabilitation and LT in those 4 patients. We measured FVC, FEV1, 6-minutes walk distance (6MWD) and peak oxygen consumption during a treadmill exercise test. We also measured activity of daily living (ADL), sickness impact profile (SIP), and the State-trait Anxiety Inventory (STAI). Before LT, while the patients were all waiting for surgery, rehabilitation improved exercise tolerance and ADL without significant change in FVC or FEV1. Then, however, the improvement gradually deteriorated through the waiting period. After LT, FVC, FEV1 and exercise tolerance significantly increased. SIP, which measures health related quality of life, also ameliorated to the level of unimpaired individuals in the physical dimension, but did not reach that level in the psychological dimension. STAI, general anxiety scores, did not significantly change. ADL tended to improve short of breathlessness, moving speed, and supplemental oxygen requirement, but these changes were not significant. After LT, 6MWD increased from 148m at 62 post-operative days (POD) to 342m at their discharge from the hospital (121 POD on average). All cases were discharged to their homes. Three transplant recipients successfully returned to work, however, one patient died of aspergillosis in the native lung about 1 year after LT. These improvements cover a broad activity range, and lead to an increase in patients' stress. Environmental change, for example, being discharged from hospital or returning to work, causes the patients' STAI score to increase. These results indicate that careful management and comprehensive rehabilitation including mental care is needed for LT candidates both before and after LT.

Key words: lung transplantation, exercise tolerance, quality of life, activities of daily living, donor card