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Background: Physical fitness after lung transplantation (LTx) is often severely reduced, despite improvement in lung function. Low physical fitness is associated with increased mortality. We hypothesized that high-intensity training (HIT) would improve peak oxygen uptake (VO2peak) and muscular strength after LTx. Methods: In a randomized controlled trial, 54 LTx-recipients were enrolled 6-60 months after surgery. The HIT group (n=25) followed a 20-week endurance and strength training program three times a week. The control group (n=29) followed the hospital’s general recommendations for physical activity. All patients completed a maximal cardiopulmonary exercise test, arm- and leg press pre- and post-intervention. The primary outcome was change in VO2peak as a measure of cardiorespiratory fitness. Secondary outcomes were change in one-repetition maximum (1RM) in arm- and leg press as measures of muscular strength. ANCOVA was used for per-protocol analyses based on ≥70% attendance of the prescribed sessions. Data are presented as mean±SD. Results: VO2peak at baseline was 71±14 and 68±14% of predicted in the HIT- and control group, respectively. No adverse outcomes related to HIT were reported. Conclusion: HIT improved VO2peak and muscular strength. HIT may represent an effective form of exercise therapy that improves physical fitness and health outcomes after lung transplantation.

Introduction: A thorough risk stratification is necessary to select and allocate patients with cystic fibrosis (CF) for lung transplantation (LTx). Aims: We aimed to estimate survival benefit of LTx in CF in Norway by using validated tools for risk stratification. Methods: All CF patients listed for LTx in Norway from 1990 to 2018 were included. Data was obtained from the national LTx registry and by review of medical records. We evaluated post-LTx survival by Kaplan-Meier statistics. A predicted 5-year survival was calculated in retrospect from baseline characteristics at transplant (Liou score) that stratified patients to risk groups. Survival benefit was inferred by comparing observed post-LTx survival with predicted survival in each risk stratum. Results: In total, 67 CF patients were listed for LTx, of whom 14 died on waitlist and 51 were transplanted. Overall 1-year, 5-year and 10-year survival after LTx was 88%, 66% and 62%, respectively. Median survival from listing was 11,4 years (95% CI: 9.2-13,6) and post-LTx 11,1 years (95% CI: 8.0-14,3), while median survival for those who died on waitlist was 0,65 years (95% CI: 0,0-2,7). Comparison of the observed post-LTx 5-year survival to the predicted using the Liou-risk score indicated greatest survival benefit for the risk group that had a modeled 5-year survival without LTx of 30-50%, while those >70% had no survival benefit. Conclusions: The survival rate of CF patients after LTx in Norway is similar to internationally published data. LTx increases survival significantly compared to the observed survival on the waitlist and patients of intermediary risk seem to have the greatest survival benefit.

Introduction: Cardiorespiratory fitness (VO2peak) remains low after lung transplantation (LTx) despite improvement in lung function. The extent and reasons for this are unclear. Aim: To evaluate the cardiopulmonary response during a maximal cardiopulmonary exercise test (CPET) in LTx recipients, and to detect exercise limiting factors. Method: Bilateral-LTx recipients (n=47, age 20-67 years, 23 men) underwent a treadmill CPET. Exercise limiting factors were classified as a breathing reserve (BR) Results: Median (range) time since LTx was 29 (6-59) months. The table shows the physiological response during CPET. Five patients had a VO2peak within normal range (VO2peak>80% predicted). Six patients had a small BR, which indicates ventilatory limitations, and 3 had exercise-induced hypoxemia. Thirty-five demonstrated a low VO2peak having none of the limitations above. Seventeen had inefficient ventilation, but did not desaturate. Conclusion: LTx recipients demonstrated low cardiorespiratory fitness. One-fifth had cardiorespiratory limitations, whereas a majority was deconditioned without such limitations. This may suggest a substantial need for exercise training after LTx.

Introduction: Chronic lung allograft dysfunction (CLAD) is a serious complication after lung transplantation (LTx), associated with elevated proportions of neutrophils (%PMN) in bronchoalveolar lavage (BAL). Induced sputum (IS) is less invasive than BAL to assess markers of inflammation (%PMN) in central airways. Aims: To examine whether IS %PMN levels were elevated early after LTx and further compare the utility of IS (vs BAL) %PMN to predict CLAD development. Methods: IS and BAL samples were collected at 4-8 and 12 weeks post LTx and IS collected annually in 30 patients, of which 10 later developed CLAD. The %PMN were determined by differential cell count and flow cytometry. CLAD was diagnosed in accordance with international guidelines. Results: CLAD occurred after a mean (SD) of 245 (156) days. At this time, %PMN in IS was higher among patients with CLAD, being 69 (17)% vs 49 (21)%, p=0.01. There were no statistical differences in %PMN in BAL or IS at earlier time points between those who later developed CLAD and those who did not. Using logistic regression, we found no relationship between %PMN at either 4-8 or 12 weeks after transplant, and presence of CLAD at 1, 2 or 3 years post LTx. Conclusion: The %PMN significantly discriminated CLAD from non-CLAD patients at time of diagnosis. The %PMN in samples of BAL and IS taken early after LTx did not predict development of CLAD up to 3 years post LTx. IS appears to give comparable information to BAL early after LTx and may be considered as a less invasive alternative to BAL for PMN surveillance post LTx.

Introduction: To extend the number of available organs for lung transplantation (LTx), donors with a smoking history are increasingly accepted. Previous studies show conflicting results as to whether this impairs recipient survival. Aims and objectives: The aim was to assess the effects of using lungs from donors with a smoking history for LTx for recipients with cystic fibrosis (CF). Methods: All recipients of bilateral LTx in Norway and Denmark 1990-2013 were included. Donor information and data about recipient survival and lung function was extracted from existing registries. Results: While there was no negative effect of donor smoking status when including all LTx recipients (n=388), we found a negative association between donor smoking status and post-LTx survival in the CF patients (n=86), in whom one-year survival was 82 % vs 90 % and five year survival was 49 % vs 73 % comparing smoking to non-smoking donors (Log-rank p-value 0.005). The negative effects of using organs from smoking donors remained significant when adjusting for donor and recipient age and sex, organ ischemia time and transplant center location in multivariate cox regression analysis. Conclusion: Using donors with a positive smoking history in double lung transplant recipients with cystic fibrosis is associated with inferior survival and decreased lung function.