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366: Patterns and predictors of physical functional disability at 5-10 years after heart transplantation
The Journal of Heart and Lung Transplantation Volume 26, Number 2S
Conclusions: Despite longer ischemic times of UNOS donors (mainly due to longer transit times), donor origin was not an independent predictor of survival in heart or lung transplant recipients. One-month and one-year survival were excellent in recipients receiving UNOSrejected donor hearts and lungs. UNOS rejection is not a risk factor for successful heart or lung transplantation. 364
Abstracts
S191
J.K. Kirklin,2 1Cardiothoracic Surgery, Northwestern Memorial Hospital, Chicago, IL; 2Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL; 3Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH; 4Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL; 5 Cardiology, Loyola University Medical Center, Maywood, IL; 6 Psychology, Virginia Commonwealth University, Richmond, VA; 7 UCLA Heart and Lung Transplant Program, UCLA Medical Center, Los Angeles, CA
WITHDRAWN 365 PROSPECTIVE, RANDOMIZED INTERVENTION ON PHYSICAL FUNCTIONING AND HRQOL AFTER LUNG TRANSPLANTATION C. Kugler,1 U. Tegtbur,2 J. Gottlieb,3 A. Simon,1 M. Dierich,3 T. Welte,3 A. Haverich,1 M. Strueber,1 1Hannover Thoracic Transplant Program; Div. of Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany; 2Sportsphysiology/Medicine, Hannover Medical School, Hannover, Germany; 3Div. of Pulmonary Medicine, Hannover Medical School, Hannover, Germany Purpose: The aim of this prospective, randomized intervention was to initiate a controlled home based physical reconditioning program and to evaluate training effects on health-related quality of life (HRQoL) in patients after lung transplantation (LTx). Methods and Materials: 42 consecutive patients were randomized in either intervention (IG; n⫽21) or control group (CG; n⫽21) and were followed with cardiopulmonary exercise testings and HRQoL measurements (SF-36) for 15⫾3 months after LTx. Patient characteristics did not differ concerning age (IG 47⫾11/ CG 46⫾9), gender (female IG 9/ CG 10), body mass index (IG 23⫾3/ CG 23⫾3 kg/m-2), and pulmonary function using FEV1 (IG 2.4⫾0.9/ CG 2.6⫾0.9 l). IG patients performed a supervised home based ergometer training; training protocols were programmed on smart cards and readapted monthly after analysis of electronic data. CG patients were encouraged to perform regular exercise training. Results: A total of 2650 training sessions (2.2⫾1.0 per week) were performed without adverse events. Before intervention no significant differences occurred between IG and CG for HRQoL; neither differences in maximum exercise capacity (in watt) (IG: 68⫾22/ CG: 72⫾17), nor significant differences in maximum oxygen consumption (in ml/min-1/kg-1) were seen between IG (17⫾3) and CG (20⫾5). Following intervention differences in HRQoL between IG and CG were identified for life satisfaction (p⬍0.01), and for SF-36 subscales physical functioning (p⬍0.04), role physical (p⬍0.03), and mental health (p⬍0.05). Cardiopulmonary exercise testing revealed a significant increase in maximum exercise capacity (p⬍0.01) in IG (83⫾22; ⫹26%; p⬍0.01) compared to CG (75⫾20; ⫹4%; n.s.). Peak oxygen consumption was significantly increased in IG (IG: 20⫾6; ⫹13%; p⬍0.01/ CG: 17⫾4; ⫹5%; n.s.). Conclusions: Exercise capacity was increasing over 15 months. Patients after LTx benefit from controlled home based physical reconditioning programs concerning their HRQoL. Physical reconditioning for patients after LTx need to be established for the long-term. 366 PATTERNS AND PREDICTORS OF PHYSICAL FUNCTIONAL DISABILITY AT 5-10 YEARS AFTER HEART TRANSPLANTATION K.L. Grady,1 D.C. Naftel,2 J.B. Young,3 D. Pelegrin,3 J. Czerr,3 R. Higgins,4 A. Heroux,5 M. McLeod,4 B. Rybarczyk,6 J. Kobashigawa,7 J. Chait,7 C. White-Williams,2 S. Myers,2
Purpose: There are few studies of long-term physical function after heart transplantation (HT). Studies were cross-sectional, and no studies were found that used multivariate analyses to examine physical function from 5 to 10 years after HT. Therefore, the purposes of this study were to describe physical functional disability over time and identify predictors of physical functional disability from 5 - 10 years after HT. Methods and Materials: Prospective data were collected from a non-random sample of HT patients (pts), transplanted between 7/1/90 - 6/30/99 at 4 medical centers in the U.S. Pts. completed the following tools: Sickness Impact Profile, Assessment of Compliance with HT Regimen, Jalowiec Coping Scale, Cardiac Depression Scale, Positive and Negative Affect Schedule, and chart review data were gathered. Statistical analyses included measures of central tendency ⫾ standard deviation (plotted over time) and multiple regression coupled with repeated measures. Results: Pts. (n⫽555) were 78% male, 90% white, and mean age at time of HT ⫽ 54 ⫾ 9 years. At 5-10 years after HT, mean physical functional disability scores were low (mean⫽0.06⫾0.09, 0⫽no functional disability to 1⫽most functional disability), and 34-45% of patients reported having no physical functional disability. Predictors (with a partial R2 ⱖ 1%) of more physical functional disability were more neuromuscular symptoms, depression, more co-existing illnesses, higher New York Heart Association Class, rejection/infection/and/or CAD, female, not employed, increased body mass index, and orthopedic problems, accounting for 42% of variance (F⫽ 84.75, p⬍0.0001). Conclusions: Most pts. who are 5 - 10 years post HT have low levels of physical functional disability. Predictors of physical functional disability include demographic variables, co-morbidities, complications of HT, symptoms, and depression. These findings provide direction for the development of strategies to assist pts to reduce their level of disability or function within their level of disability and receive assistance as needed. 367 POSTTRANSPLANT INFECTIONS AFTER LUNG TRANSPLANTATION REDUCE HRQOL IN THE LONG-TERM: RESULTS OF A PROSPECTIVE COHORT STUDY C. Kugler,1 F. Mattner,2 A. Simon,1 J. Gottlieb,3 T. Welte,3 A. Haverich,1 M. Strueber,1 1Hannover Thoracic Transplant Program; Div. of Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany; 2Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany; 3 Div. of Pulmonary Medicine, Hannover Medical School, Hannover, Germany Purpose: The objective of this study was to identify prognostic factors in the early postoperative period following lung transplantation (LTx) influencing health-related quality of life (HRQoL) in the first year after LTx. Methods and Materials: A prospective, repeated-measures cohort study was conducted of 87 consecutive patients undergoing LTx (87.7% bilateral; single 12.3%). Mean age was 50.5⫾10.7; 44.7% were high urgency (HU) candidates with a mean hospital waiting time of 19 days
Conclusions: Despite longer ischemic times of UNOS donors (mainly due to longer transit times), donor origin was not an independent predictor of survival in heart or lung transplant recipients. One-month and one-year survival were excellent in recipients receiving UNOSrejected donor hearts and lungs. UNOS rejection is not a risk factor for successful heart or lung transplantation. 364
Abstracts
S191
J.K. Kirklin,2 1Cardiothoracic Surgery, Northwestern Memorial Hospital, Chicago, IL; 2Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL; 3Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH; 4Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL; 5 Cardiology, Loyola University Medical Center, Maywood, IL; 6 Psychology, Virginia Commonwealth University, Richmond, VA; 7 UCLA Heart and Lung Transplant Program, UCLA Medical Center, Los Angeles, CA
WITHDRAWN 365 PROSPECTIVE, RANDOMIZED INTERVENTION ON PHYSICAL FUNCTIONING AND HRQOL AFTER LUNG TRANSPLANTATION C. Kugler,1 U. Tegtbur,2 J. Gottlieb,3 A. Simon,1 M. Dierich,3 T. Welte,3 A. Haverich,1 M. Strueber,1 1Hannover Thoracic Transplant Program; Div. of Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany; 2Sportsphysiology/Medicine, Hannover Medical School, Hannover, Germany; 3Div. of Pulmonary Medicine, Hannover Medical School, Hannover, Germany Purpose: The aim of this prospective, randomized intervention was to initiate a controlled home based physical reconditioning program and to evaluate training effects on health-related quality of life (HRQoL) in patients after lung transplantation (LTx). Methods and Materials: 42 consecutive patients were randomized in either intervention (IG; n⫽21) or control group (CG; n⫽21) and were followed with cardiopulmonary exercise testings and HRQoL measurements (SF-36) for 15⫾3 months after LTx. Patient characteristics did not differ concerning age (IG 47⫾11/ CG 46⫾9), gender (female IG 9/ CG 10), body mass index (IG 23⫾3/ CG 23⫾3 kg/m-2), and pulmonary function using FEV1 (IG 2.4⫾0.9/ CG 2.6⫾0.9 l). IG patients performed a supervised home based ergometer training; training protocols were programmed on smart cards and readapted monthly after analysis of electronic data. CG patients were encouraged to perform regular exercise training. Results: A total of 2650 training sessions (2.2⫾1.0 per week) were performed without adverse events. Before intervention no significant differences occurred between IG and CG for HRQoL; neither differences in maximum exercise capacity (in watt) (IG: 68⫾22/ CG: 72⫾17), nor significant differences in maximum oxygen consumption (in ml/min-1/kg-1) were seen between IG (17⫾3) and CG (20⫾5). Following intervention differences in HRQoL between IG and CG were identified for life satisfaction (p⬍0.01), and for SF-36 subscales physical functioning (p⬍0.04), role physical (p⬍0.03), and mental health (p⬍0.05). Cardiopulmonary exercise testing revealed a significant increase in maximum exercise capacity (p⬍0.01) in IG (83⫾22; ⫹26%; p⬍0.01) compared to CG (75⫾20; ⫹4%; n.s.). Peak oxygen consumption was significantly increased in IG (IG: 20⫾6; ⫹13%; p⬍0.01/ CG: 17⫾4; ⫹5%; n.s.). Conclusions: Exercise capacity was increasing over 15 months. Patients after LTx benefit from controlled home based physical reconditioning programs concerning their HRQoL. Physical reconditioning for patients after LTx need to be established for the long-term. 366 PATTERNS AND PREDICTORS OF PHYSICAL FUNCTIONAL DISABILITY AT 5-10 YEARS AFTER HEART TRANSPLANTATION K.L. Grady,1 D.C. Naftel,2 J.B. Young,3 D. Pelegrin,3 J. Czerr,3 R. Higgins,4 A. Heroux,5 M. McLeod,4 B. Rybarczyk,6 J. Kobashigawa,7 J. Chait,7 C. White-Williams,2 S. Myers,2
Purpose: There are few studies of long-term physical function after heart transplantation (HT). Studies were cross-sectional, and no studies were found that used multivariate analyses to examine physical function from 5 to 10 years after HT. Therefore, the purposes of this study were to describe physical functional disability over time and identify predictors of physical functional disability from 5 - 10 years after HT. Methods and Materials: Prospective data were collected from a non-random sample of HT patients (pts), transplanted between 7/1/90 - 6/30/99 at 4 medical centers in the U.S. Pts. completed the following tools: Sickness Impact Profile, Assessment of Compliance with HT Regimen, Jalowiec Coping Scale, Cardiac Depression Scale, Positive and Negative Affect Schedule, and chart review data were gathered. Statistical analyses included measures of central tendency ⫾ standard deviation (plotted over time) and multiple regression coupled with repeated measures. Results: Pts. (n⫽555) were 78% male, 90% white, and mean age at time of HT ⫽ 54 ⫾ 9 years. At 5-10 years after HT, mean physical functional disability scores were low (mean⫽0.06⫾0.09, 0⫽no functional disability to 1⫽most functional disability), and 34-45% of patients reported having no physical functional disability. Predictors (with a partial R2 ⱖ 1%) of more physical functional disability were more neuromuscular symptoms, depression, more co-existing illnesses, higher New York Heart Association Class, rejection/infection/and/or CAD, female, not employed, increased body mass index, and orthopedic problems, accounting for 42% of variance (F⫽ 84.75, p⬍0.0001). Conclusions: Most pts. who are 5 - 10 years post HT have low levels of physical functional disability. Predictors of physical functional disability include demographic variables, co-morbidities, complications of HT, symptoms, and depression. These findings provide direction for the development of strategies to assist pts to reduce their level of disability or function within their level of disability and receive assistance as needed. 367 POSTTRANSPLANT INFECTIONS AFTER LUNG TRANSPLANTATION REDUCE HRQOL IN THE LONG-TERM: RESULTS OF A PROSPECTIVE COHORT STUDY C. Kugler,1 F. Mattner,2 A. Simon,1 J. Gottlieb,3 T. Welte,3 A. Haverich,1 M. Strueber,1 1Hannover Thoracic Transplant Program; Div. of Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany; 2Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany; 3 Div. of Pulmonary Medicine, Hannover Medical School, Hannover, Germany Purpose: The objective of this study was to identify prognostic factors in the early postoperative period following lung transplantation (LTx) influencing health-related quality of life (HRQoL) in the first year after LTx. Methods and Materials: A prospective, repeated-measures cohort study was conducted of 87 consecutive patients undergoing LTx (87.7% bilateral; single 12.3%). Mean age was 50.5⫾10.7; 44.7% were high urgency (HU) candidates with a mean hospital waiting time of 19 days