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Decreased Hypercapnic Ventilatory Response in Long-Term Lung Transplant Recipients is Associated with Exercise Impairment

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Abstract

Purpose

Bilateral lung transplantation results in complete denervation of the lung and might impair hypercapnic ventilatory response (HCVR). However, experimental and clinical findings are scarce and conflicting. Therefore, this study investigated the relationship between HCVR and exercise capacity after long-term bilateral lung transplantation.

Methods

This cross-sectional analysis enrolled 46 bilateral lung transplant recipients between October 2011 and July 2012 who underwent cardiopulmonary exercise testing to evaluate maximum workload, and carbon dioxide (CO2) rebreathing. CO2 rebreathing was also evaluated in 35 control subjects.

Results

In lung transplant recipients age was 54 ± 11 years, body mass index (BMI) 25.4 ± 4.1 kg/m2, and time after transplantation 4.5 ± 2.5 years (range 9 months to 10 years). Controls were aged 41 ± 12 years and had a BMI of 24.9 ± 4.0 kg/m2. There were significant differences between lung transplant recipients and controls in forced expiratory volume in 1 s (76 ± 22 vs. 94 ± 12 % predicted, p < 0.001) and inspiratory vital capacity (91 ± 20 vs. 105 ± 14 % predicted, p = 0.001). Blood gases did not differ significantly in patients versus controls. HCVR in lung transplant recipients was 1.44 ± 1.07 L/min/mmHg compared with 2.09 ± 1.14 L/min/mmHg in controls (p = 0.001). Exercise capacity in lung transplant recipients (73 ± 24 W) was 49 % predicted. Linear regression analysis showed that exercise capacity was significantly associated with HCVR. A 1 L/min/mmHg decrease in HCVR decreased exercise capacity by 50 W.

Conclusion

HCVR is reduced in long-term bilateral lung transplant recipients and this might explain the observed impairment of exercise capacity.

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Acknowledgments

English language editing assistance was provided by Nicola Ryan, independent medical writer.

Author Contributions

Manuela Scherer: contributed to collecting the data, analyzing the data, and writing the manuscript. Urte Sommerwerck: contributed to designing and supervising the study and writing the manuscript. Bjoern Kleibrink: contributed to collecting the data and revising the manuscript. Thomas Rabis: contributed to collecting the data and revising the manuscript. Markus. Kamler: contributed to revising the manuscript. Helmut Teschler: contributed to designing the study and revising the manuscript. Gerhard Weinreich: contributed to designing and supervising the study, analyzing the data, and writing the manuscript.

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Authors and Affiliations

  1. Department of Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany

    Manuela J. Scherer, Gerhard Weinreich, Bjoern E. Kleibrink, Thomas Rabis, Helmut Teschler & Urte Sommerwerck

  2. Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany

    Markus Kamler

  3. Department of Pneumology, St. Vinzenz Hospital Braunschweig, Brunswick, Germany

    Urte Sommerwerck

Authors
  1. Manuela J. Scherer
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  2. Gerhard Weinreich
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  3. Bjoern E. Kleibrink
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  4. Thomas Rabis
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  5. Markus Kamler
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  6. Helmut Teschler
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  7. Urte Sommerwerck
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Corresponding author

Correspondence to Manuela J. Scherer.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in our study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Scherer, M.J., Weinreich, G., Kleibrink, B.E. et al. Decreased Hypercapnic Ventilatory Response in Long-Term Lung Transplant Recipients is Associated with Exercise Impairment. Lung 194, 563–569 (2016). https://doi.org/10.1007/s00408-016-9889-9

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  • DOI: https://doi.org/10.1007/s00408-016-9889-9

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