【論文摘要】The Effect of Pre-transplant Pulmonary Rehabilitation on Functional Exercise Capacity in a Patient With Restrictive Lung Disease-A Case Report

Abstract

Background and Purpose: Six-minute walk test often serves as a functional exercise capacity assessment before lung transplantation and distance walked in six-minute (6MWD) was a significant predictor for waitlist mortality among lung transplant candidates. The cut-off value for worse survival after transplantation was 250 m. Patients with severe restrictive lung disease often had poor 6MWD. Whether pre-transplant pulmonary rehabilitation (PR) could improve 6MWD surpass this cut-off value remained to be determined. This case report aimed to describe the effect of pre-transplant PR on 6MWD in a patient with severe restrictive lung disease. Methods: The patient was a 52-year-old female diagnosed with lymphangioleiomyomatosis preparing for lung transplantation and was referred to the physical therapist for PR in August 2017. The patient was on long-term supplemental oxygen therapy. Activities of daily living (ADL) were partially dependent, and a wheelchair was required for outdoor activities before PR. Forced vital capacity (FVC) and DLCO was 1.21 L (46.9% predicted) and 2.43 (13.5 % predicted) before PR, respectively. The baseline 6MWD was 153 m (25.6 % predicted). The patient started supervised once weekly PR program, which consisted of chest physiotherapy, breathing retraining, and exercise training. Heart rate and oxygen saturation were monitored throughout all training sessions, and oxygen supplement was adjusted depending on the oxygen saturation during the training. Home-based exercise was also encouraged, and exercise log was provided. Results: The patient received a total of 125 weeks PR. 6MWD improved to 315 m after 56 weeks of PR and maintained above 250 m for the rest of the pre-transplant training. Handgrip strength increased from 17 kg to 22 kg. Training intensity improved from 6 watts to 20 watts. No adverse events were observed during pre-transplant PR sessions. The patient received lung transplant in January 2020 and discharged successfully in February 2020. Conclusion: The reported case of severe restrictive lung disease was able to reach a 6MWD ＞ 250 m cut-off value after pre-transplant PR. Clinical Relevance: Pre-transplant hospital-based supervised PR is feasible for lung transplant candidate with severe restrictive lung disease.