• ECMO duration
• bridge to transplantation
• extracorporeal membrane oxygenation
• learning curve
• lung transplantation

• Humans
• Lung Transplantation/mortality
• Lung Transplantation/methods
• Extracorporeal Membrane Oxygenation
• Male
• Female
• Middle Aged
• Adult
• Retrospective Studies
• Treatment Outcome
• Time Factors
• Hospitals, High-Volume
• Aged

• Analgesia
• Chronic pain
• Chronic postsurgical pain
• Lung transplantation
• Pain management

• diaphragm
• diaphragm dysfunction
• lung transplantation
• phrenic nerve
• review

• Humans
• Diaphragm
• Lung Transplantation
• Postoperative Complications/etiology

• latent profile analysis
• lung transplant recipients
• mindfulness
• nursing
• optimism
• quality of life

• Humans
• Quality of Life/psychology
• Lung Transplantation/psychology
• Female
• Male
• Middle Aged
• Adult
• Transplant Recipients/psychology
• Transplant Recipients/statistics & numerical data
• Surveys and Questionnaires
• China
• Mindfulness
• Latent Class Analysis

• Medical outcomes
• Organ transplantation
• Prevention
• Psychological outcomes
• Transplant evaluation

• Humans
• Risk Factors
• Lung Transplantation

• Breathing exercises
• Exercise capacity
• Inspiratory muscle training
• Lung transplantation
• Pulmonary rehabilitation
• Respiratory muscle training

• Humans
• Pulmonary Disease, Chronic Obstructive

• chronic obstructive pulmonary disease
• interstitial lung disease
• pulmonary hypertension
• pulmonary rehabilitation
• telerehabilitation

• Adult
• Humans
• Hypertension, Pulmonary
• Lung Diseases, Interstitial
• Pulmonary Disease, Chronic Obstructive
• Quality of Life
• Respiration Disorders
• Societies
• United States

• patient-centered care
• telemedicine
• transplant medicine

• Humans
• Iran
• Feasibility Studies
• Qualitative Research
• Lung Transplantation
• Ambulatory Care Facilities
• General Practitioners

• Advanced age
• Body mass index
• Frailty
• Lung transplantation
• Preexisting cancers
• Systemic autoimmune rheumatic disease

• exercise
• exercise ability
• lung transplant
• quality of life
• rehabilitation
• survival

• United Network for Organ Sharing
• fragility
• functional status
• lung transplantation
• survival

• Lung transplantation
• physical activity
• tele-rehabilitation

Lung transplantation is considered a viable treatment option for patients with end-stage lung disease. Recent decades have seen a gradual increase in the number of lung transplantation patients worldwide, and in South Korea, the case number has increased at least 3-fold during the last decade. Furthermore, the waiting list time is becoming longer, and more elderly patients (>65 years) are undergoing lung transplantation; that is, the patients placed on the waiting list are older and sicker than in the past. Hence, proper management during the pre-transplantation period, as well as careful selection of candidates, is a key factor for transplant success and patient survival. Although referring and transplant centers should address many issues, the main areas of focus should be the timing of referral, nutrition, pulmonary rehabilitation, critical care (including mechanical ventilation and extracorporeal membrane oxygenation), psychological support, and the management of preexisting comorbid conditions (coronary artery disease, diabetes mellitus, gastroesophageal reflux disease, osteoporosis, malignancy, viral infections, and chronic infections). In this context, the present article reviews and summarizes the pre-transplantation management strategies for adult patients listed for lung transplantation.

• Adult
• Exercise Therapy/methods
• Humans
• Lung Transplantation/adverse effects
• Preoperative Exercise
• Prospective Studies
• Quality of Life
• Treatment Outcome

Persistent orthostatic hypotension (OH) is a lesser-known complication of lung transplantation (LTx). In this retrospective case series, we describe the clinical manifestations, complications, and treatment of persistent OH in 13 LTx recipients.

We identified LTx recipients who underwent transplantation between March 1, 2018, and March 31, 2020, with persistent symptomatic OH and retrospectively queried the records for clinical information.

Thirteen patients were included in the analysis, 9 (69%) had underlying pulmonary fibrosis, and 12 (92%) were male. The median age, height, and body mass index at LTx were 68 years, 70 inches, and 27 kg/m², respectively. Six (46%) patients were deceased at the time of chart abstraction with a median (IQR) posttransplant survival of 12.6 months (6, 21); the 7 remaining living patients were a median of 19.6 months (18, 32) posttransplant. Signs and symptoms of OH developed a median of 60 (7, 75) days after transplant. Patients were treated with pharmacological agents and underwent extensive physical therapy. Most patients required inpatient rehabilitation (n = 10, 77%), and patients commonly developed comorbid conditions including weight loss, renal insufficiency with eGFR <50 (n = 13, 100%), gastroparesis (n = 7, 54%), and tachycardia-bradycardia syndrome (n = 2, 15%). Falls were common (n = 10, 77%). The incidence of OH in LTx recipients at our center during the study period was 5.6% (13/234).

Persistent OH is a lesser-known complication of LTx that impacts posttransplant rehabilitation and may lead to comorbidities and shortened survival. In addition, most LTx recipients with OH at our center were tall, thin men with underlying pulmonary fibrosis, which may offer an opportunity to instate pretransplant OH screening of at-risk patients.

• Pulmonary hypertension (PHTN)
• cystic fibrosis (CF)
• extra-corporeal life support
• frailty
• protective lung ventilation
• regional pain management techniques
• transesophageal echocardiography (TEE)

• female
• humans
• male
• middle aged
• bias
• bone density
• cause of death
• exercise
• exercise tolerance
• forced expiratory volume
• lung transplantation
• lung transplantation/rehabilitation
• muscle strength
• program evaluation
• quality of life
• randomized controlled trials as topic
• resistance training
• time factors
• transplant recipients
• walk test

• Bias
• Bone Density
• Cause of Death
• Exercise
• Exercise Tolerance
• Female
• Forced Expiratory Volume
• Humans
• Lung Transplantation/rehabilitation
• Male
• Middle Aged
• Muscle Strength
• Program Evaluation
• Quality of Life
• Randomized Controlled Trials as Topic
• Resistance Training
• Time Factors
• Transplant Recipients
• Walk Test

Prehabilitation has shown its potential for most intra-cavity surgery patients on enhancing preoperative functional capacity and postoperative outcomes. However, its large-scale implementation is limited by several constrictions, such as: i) unsolved practicalities of the service workflow, ii) challenges associated to change management in collaborative care; iii) insufficient access to prehabilitation; iv) relevant percentage of program drop-outs; v) need for program personalization; and, vi) economical sustainability. Transferability of prehabilitation programs from the hospital setting to the community would potentially provide a new scenario with greater accessibility, as well as offer an opportunity to effectively address the aforementioned issues and, thus, optimize healthcare value generation. A core aspect to take into account for an optimal management of prehabilitation programs is to use proper technological tools enabling: i) customizable and interoperable integrated care pathways facilitating personalization of the service and effective engagement among stakeholders; ii) remote monitoring (i.e. physical activity, physiological signs and patient-reported outcomes and experience measures) to support patient adherence to the program and empowerment for self-management; and, iii) use of health risk assessment supporting decision making for personalized service selection. The current manuscript details a proposal to bring digital innovation to community-based prehabilitation programs. Moreover, this approach has the potential to be adopted by programs supporting long-term management of cancer patients, chronic patients and prevention of multimorbidity in subjects at risk.

• behavioral change
• eHealth
• exercise training and nutrition counseling
• mHealth
• physical activity
• prehabilitation
• psychological well-being
• technology – ICT

• HRQoL
• exercise
• exercise capacity
• solid organ transplant
• transplantation

A supervised combined training program was applied to a sedentary 56-year-old man with idiopathic pulmonary fibrosis (IPF) along three years, until lung transplantation. It included: (a) aerobic continuous (CT) and interval training (IT), (b) high load resistance training (RT) and (c) inspiratory muscle training (IMT). IT and IMT were applied for two years, while CT and RT could be maintained until transplantation using supplemental oxygen. Maximal inspiratory pressure (MIP) kept above 180 cm H₂O and forced vital capacity (FVC) remained stable until lung transplantation. Peak oxygen uptake VO₂ increased during 1.5 years before its decline, staying above the poor prognosis level two years. Finally, the patient maintained his walking capacity and independence for 2 years, before the decline due to the disease. After receiving a two-lung transplant, the patient remained intubated for 12 h, left the intensive care unit after 3.5 days and was discharged after 18 days (average values: 48 h, 7–10 days and 25–35 days, respectively). These results show that systematic and supervised combined training can be safety applied in an IPF patient to maintain functionality and quality of life. In addition, we show that RT can be maintained for as long as necessary without complications.

• idiopathic pulmonary fibrosis
• inspiratory muscle training
• resistance training

• Breathing Exercises
• Humans
• Idiopathic Pulmonary Fibrosis/therapy
• Inhalation
• Male
• Middle Aged
• Quality of Life
• Respiratory Muscles/physiology
• Vital Capacity

• Adult
• Exercise/psychology
• Female
• Health Behavior
• Humans
• Italy
• Life Style
• Male
• Middle Aged
• Organ Transplantation/psychology
• Organ Transplantation/rehabilitation
• Patient Compliance/psychology
• Postoperative Period
• Preoperative Period
• Renal Dialysis/psychology
• Retrospective Studies
• Sedentary Behavior
• Sports
• Waiting Lists

• lung transplantation

• R01 NR017801 NINR NIH HHS

Barriers and motives towards physical activity (PA) in lung transplant (LTx) recipients with cystic fibrosis (CF) are largely unknown. We aimed to explore perceptions towards PA in LTx recipients with CF to better understand individuals’ needs and preferences.

Participants completed an online survey at two Swiss LTx and one follow-up shared care centre between June and December 2018.

One hundred and eleven individuals completed the survey (87.4% response rate). Overall, survey participants perceive PA as important for their daily life and health. Perceived motives of PA were improving muscle strength, endurance and quality of life (QoL), to feel better, fun, to achieve personal goals and having more energy for everyday life. Fatigue was the most common perceived barrier to PA and associated with poorer QoL (r = -0.43, p<0.001) and health status (r = -0.31, p = 0.001). Participants with lung allograft dysfunction (LAD, n = 20) reported lower habitual PA (p = 0.009) and health status (p = 0.011), and rated shortness of breath, bad weather and concerns regarding lung rejection higher than those without LAD (all p<0.05). When we asked how an optimal training programme should look like, the majority would prefer individual, non-supervised (60%), outdoor (77%), endurance training (90%), once or twice a week (47%) for 40–60 minutes (48%). Only a minority of patients (14%) would be willing to use exercise applications for their home-based training.

LTx recipients with CF value PA as important for their health. People with CF should be encouraged individually by their multidisciplinary transplant team to implement PA in their daily life, potential barriers should be identified and addressed. Overall, knowledge on perceived barriers and motives for PA should be considered in the development of future patient-centred PA programmes.

• Adult
• Cystic Fibrosis/physiopathology
• Cystic Fibrosis/psychology
• Cystic Fibrosis/surgery
• Exercise
• Female
• Health Knowledge, Attitudes, Practice
• Humans
• Lung Transplantation
• Male
• Motivation
• Quality of Life
• Surveys and Questionnaires
• Transplant Recipients/psychology

• Diseases
• Exercise prescription
• Patients

• Bronchiolitis Obliterans Syndrome
• Capacidad funcional de ejercicio
• Disnea
• Dyspnea
• Functional exercise capacity
• Lung transplantation
• Síndrome de bronquiolitis obliterante
• Trasplante pulmonar

• Adult
• Aged
• Bronchiolitis Obliterans/etiology
• Bronchiolitis Obliterans/physiopathology
• Case-Control Studies
• Dyspnea/etiology
• Exercise
• Exercise Tolerance
• Fatigue/etiology
• Female
• Follow-Up Studies
• Forced Expiratory Volume
• Humans
• Lung Transplantation
• Male
• Middle Aged
• Postoperative Complications/etiology
• Postoperative Complications/physiopathology
• Retrospective Studies

Physical function may influence perioperative outcomes of lung transplantation. We investigated the feasibility of a pulmonary rehabilitation program initiated in the immediate postoperative period at an intensive care unit (ICU) for patients who underwent lung transplantation.

We retrospectively evaluated 22 patients who received pulmonary rehabilitation initiated in the ICU within 2 weeks after lung transplantation at our institution from March 2015 to February 2016. Levels of physical function were graded at the start of pulmonary rehabilitation and then weekly throughout rehabilitation according to criteria from our institutional pulmonary rehabilitation program: grade 1, bedside (G1); grade 2, dangling (G2); grade 3, standing (G3); and grade IV, gait (G4).

The median age of patients was 53 years (range, 25 to 73 years). Fourteen patients (64%) were males. The initial level of physical function was G1 in nine patients, G2 in seven patients, G3 in four patients, and G4 in two patients. Patients started pulmonary rehabilitation at a median of 7.5 days (range, 1 to 29 days) after lung transplantation. We did not observe any rehabilitation-related complications during follow-up. The final level of physical function was G1 in six patients, G3 in two patients, and G4 in 14 patients. Fourteen of the 22 patients were able to walk with or without assistance, and 13 of them maintained G4 until discharge; the eight remaining patients never achieved G4.

Our results suggest the feasibility of early pulmonary rehabilitation initiated in the ICU within a few days after lung transplantation.

• intensive care units
• lung transplantation
• rehabilitation

Introduction: This systematic review aimed to assess the replicability of physical exercise interventions in lung transplantation patients. For replicability we focused on (1) the description of training principles, (2) the description of FITT components and adherence to the interventions, (3) the amount of detailed information given on the physical exercise intervention, and (4) reporting the methodological quality of the included works.

Methods: Relevant databases (Medline-Ovid, EMBASE, CINAHL, PsychInfo, Cochrane Library) were searched. Author dyads selected and systematically analyzed the included studies independent from each other. A purpose developed checklist was used to assess the details of the exercise interventions and their methodological quality.

Results: From the seven included manuscripts, three described resistance training, one endurance, and three combined training approaches. All manuscripts reported specificity and initial values, six manuscripts mention progression and overload. The exercise principle reversibility was reported once and diminishing returns was not reported at all. All studies reported the type of exercise, three studies reported intensity and one study reported time for training. Not any study completely reported frequency or described adherence to the intervention. Lack of detailed reporting was identified as the cause for murky description of the interventions. The highest score for intervention description was 5 of possible 12 items.

Conclusions: Replicability of many exercise interventions in LTX is not warranted due too poor descriptions of important items related to training. In particular there were insufficiently detailed reporting of training principles and FITT components in programs developed for LTX. Future interventions that aim to train LTX patients should spent effort in writing reports in which the intervention is detailed to such an extent that full replicability in clinical settings can be guaranteed.

• adherence
• exercise
• lung transplant
• methodological
• systematic review
• tidier checklist

• Lung Transplantation
• Psychosocial Evaluation
• Psychosocial Outcomes
• Transplant Evaluation Rating Scale (TERS)
• Transplant Recipients

• 6-minute walk test
• Rehabilitation
• exercise
• maximal inspiratory pressure
• transplantation

• Lung diseases
• Lung transplantation
• Physical therapy
• Rehabilitation

• Chronic Disease
• Exercise Therapy/adverse effects
• Exercise Therapy/methods
• Exercise Therapy/psychology
• Exercise Tolerance
• Humans
• Lung Diseases/physiopathology
• Lung Diseases/rehabilitation
• Lung Diseases/surgery
• Lung Transplantation
• Preoperative Period
• Quality of Life
• Resistance Training/adverse effects
• Respiratory Muscles/physiopathology
• Survival Rate
• Waiting Lists
• Walk Test

• Pró-Reitoria de Pesquisa, Universidade Federal de Minas Gerais
• Conselho Nacional de Desenvolvimento Científico e Tecnológico