A new study explores the impact of physical health on lung transplant outcomes.

Most adult transplant centers require patients to walk a set distance in under six minutes to remain a good candidate for transplant.
The thought behind this is that if the individual cannot meet this minimal threshold, then their chances of being able to rehabilitate following transplant are diminished. In pediatrics, this is also important. But Dawn Freiberger, RN, MSN, Boston Children’s Hospital’s Lung Transplant coordinator, pictured left, says there are other factors that have to be considered as well.

“The walk test is just one piece of the pie,” says Freiberger.

In 2012, Freiberger co-authored a study, Pretransplant six-minute walk test predicts peri- and post-operative outcomes after pediatric lung transplantation, which has become a precursor to a multi-center study with The Children’s Hospital of Philadelphia and St. Louis Children’s Hospital. The new study looks at how a pediatric patient’s pre-transplant physical condition affects post-transplant outcomes.

“A lot of centers believe if you are not physically fit you have a lesser chance of survival,” she says. “But children are different than adults; they can be physically fit in other ways. Kids exercise without realizing they are exercising.”

Freiberger and co-investigator Anne Gould, PT, of the Division of Pulmonary and Respiratory Diseases at Boston Children’s, are following 40 patients until they are one-year post transplant.

“We are studying pre-transplant variables such as the ability to walk without the aid of a wheelchair or walker, if the patient is bedbound, school attendance, whether the patient is compliant with their physical therapy program and also looking at the need for oxygen or any assisted ventilation.”

The study also includes documentation of children on mechanical support: Have they had a tracheostomy? Are they on ECMO, which provides heart-lung bypass support?

“We want to get a good picture of what these kids look like pre-transplant as far as their mobility,” Freiberger says. “The goal is for these patients to be ambulatory while on these devices.”

Recording the six-minute walk test is just one of many factors the investigators are documenting. Post transplant they are studying how many days the patient spent in the intensive care unit (ICU), length of time on a ventilator, and the number of days it took them to get out of bed post transplant.

“The ultimate test is survival.”

At some adult centers if a patient can’t walk 500 feet they are considered too sick for transplant and may be temporarily removed from the list. Freiberger says there needs to be more research showing when a child is actually too sick.

“We are trying to figure out if there are better indicators in pediatrics by looking at all the different variables, without just saying you have to be able to do ABC to be a transplant candidate.”