The utility of preoperative six-minute-walk distance in lung transplantation

Castleberry, Anthony W; Englum, Brian R; Snyder, Laurie D; Worni, Mathias; Osho, Asishana A; Gulack, Brian C; Palmer, Scott M; Davis, R Duane; Hartwig, Matthew G (2015). The utility of preoperative six-minute-walk distance in lung transplantation. American journal of respiratory and critical care medicine, 192(7), pp. 843-852. American Lung Association 10.1164/rccm.201409-1698OC

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RATIONALE The use of 6-minute-walk distance (6MWD) as an indicator of exercise capacity to predict postoperative survival in lung transplantation has not previously been well studied. OBJECTIVES To evaluate the association between 6MWD and postoperative survival following lung transplantation. METHODS Adult, first time, lung-only transplantations per the United Network for Organ Sharing database from May 2005 to December 2011 were analyzed. Kaplan-Meier methods and Cox proportional hazards modeling were used to determine the association between preoperative 6MWD and post-transplant survival after adjusting for potential confounders. A receiver operating characteristic curve was used to determine the 6MWD value that provided maximal separation in 1-year mortality. A subanalysis was performed to assess the association between 6MWD and post-transplant survival by disease category. MEASUREMENTS AND MAIN RESULTS A total of 9,526 patients were included for analysis. The median 6MWD was 787 ft (25th-75th percentiles = 450-1,082 ft). Increasing 6MWD was associated with significantly lower overall hazard of death (P < 0.001). Continuous increase in walk distance through 1,200-1,400 ft conferred an incremental survival advantage. Although 6MWD strongly correlated with survival, the impact of a single dichotomous value to predict outcomes was limited. All disease categories demonstrated significantly longer survival with increasing 6MWD (P ≤ 0.009) except pulmonary vascular disease (P = 0.74); however, the low volume in this category (n = 312; 3.3%) may limit the ability to detect an association. CONCLUSIONS 6MWD is significantly associated with post-transplant survival and is best incorporated into transplant evaluations on a continuous basis given limited ability of a single, dichotomous value to predict outcomes.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery

UniBE Contributor:

Worni, Mathias

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1073-449X

Publisher:

American Lung Association

Language:

English

Submitter:

Lilian Karin Smith-Wirth

Date Deposited:

30 Mar 2016 13:46

Last Modified:

14 Apr 2020 13:13

Publisher DOI:

10.1164/rccm.201409-1698OC

PubMed ID:

26067395

Uncontrolled Keywords:

exercise tolerance; lung transplantation; patient outcome assessment

BORIS DOI:

10.7892/boris.77520

URI:

https://boris.unibe.ch/id/eprint/77520

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