Value of exercise testing to estimate post-operative complications and mortality in solid organ recipients: a...

The pre-operative pulmonary risk assessment of solid organ transplant recipients is crucial to decrease post-operative pulmonary mortality and morbidity. Spirometry is the most commonly utilized test to predict post-operative pulmonary complications. This study was performed to evaluate the role of Cardiopulmonary Exercise Testing (CPET) in both heart and kidney transplantation recipients.

Patients referred for pulmonary evaluation between August 2008 and June 2009 prior to solid organ transplantation were included in this study. Patients' history, demographics, and physical examination were recorded. All patients performed pulmonary function tests (PFTs) and symptom-limited CPET. Thirty-four subjects (21 with heart failure and 16 with chronic renal failure) awaiting solid organ transplantation were enrolled to this study prospectively.

No pulmonary complication was found in the renal transplantation recipients, and there were pulmonary complications in 10 heart transplantation recipients. There was no difference between spirometric parameters with post-operative early pulmonary complications and mortality (p>0.05) in heart and kidney transplantation recipients. Anaerobic threshold oxygen uptake (VO(2)@AT) was significantly decreased, while minute ventilation to carbon dioxide output (VE/VCO(2)@AT) was increased in heart recipients (p<0.05).

CPET parameters measured at anaerobic threshold could help predict surgical mortality and pulmonary complications following heart transplantation. However, our study demonstrated that CPET parameters could not predict post-operative mortality and pulmonary complications in renal recipients. Therefore, heart transplant candidates should be routinely evaluated with CPET and spirometry to estimate post-operative early mortality and pulmonary complications pre-operatively.