Pulmonary Rehabilitation and Exercise Capacity, Rehospitalization, and Survival After Lung Transplant

PURPOSE: This study aimed to investigate the relationships between the dose of post-lung transplantation (LTx) pulmonary rehabilitation (PR) and exercise capacity, rehospitalization, and survival in LTx recipients. METHODS: Demographic and clinical data of LTx recipients from January 2020 to April 2023 were extracted and reviewed. The association between PR and the pre- to post-PR change in 6-minute walk test distance (6MWTd) was determined using lasso regression for variable selection followed by multiple linear regression. The association between the number of PR sessions completed and rehospitalization and survival after LTx was determined using negative binomial regression and Cox proportional hazards models. RESULTS: Aerobic training volume was a significant independent predictor of 6MWTd improvement from pre- to post-PR (β = .318, P < .001). Each additional PR session was associated with a 4.7-m greater 6MWTd (P = .010), a 3.8% lower rate of rehospitalization within 1 year of transplantation (IRR = 0.962, P = .078), and a 9.0% lower mortality risk (HR = 0.910, P = .052). Completing 16 to 27 PR sessions was associated with a 48% lower rehospitalization rate (IRR = 0.518, P =.037) and a 73% lower mortality risk (HR = 0.266, P = .071) compared with completing 1 to 11 sessions. CONCLUSIONS: Greater aerobic training volume was an independent predictor of improved exercise capacity, while a greater number of PR sessions was associated with fewer total rehospitalizations within 1 year of LTx and a trend toward improved survival.