Longitudinal recovery of physical function after lung transplantation: a comparative analysis of ECMO and non-ECMO recipients

Lung transplantation (LT) improves survival in patients with end-stage lung disease; however, recovery of physical function after transplantation remains insufficiently characterized, particularly in critically ill recipients bridged with extracorporeal membrane oxygenation (ECMO). Understanding longitudinal functional recovery and potential differences between ECMO and non-ECMO recipients is essential for optimizing post-transplant rehabilitation strategies. We retrospectively analyzed 84 adult patients who underwent lung or heart–lung transplantation between 2018 and 2023. Physical function was assessed at 6 and 12 months using the 6-minute walk test, gait speed, and strength measures. Changes over time and group differences were evaluated using longitudinal statistical models. Fifty patients (59.5%) required ECMO support. Overall physical function significantly improved from 6 to 12 months, with 93.4% achieving independent ambulation by 12 months. ECMO recipients had a lower proportion of independent ambulation at 6 months compared with non-ECMO recipients. At 12 months, no statistically significant between-group difference was observed in the proportion of patients achieving independent ambulation. LT recipients showed significant improvement in physical function between 6 and 12 months after transplantation. ECMO-bridged recipients had lower independent ambulation rates at 6 months, while no statistically significant between-group difference was observed at 12 months. Further studies incorporating pretransplant and early postoperative assessments are needed to better characterize functional recovery after lung transplantation.