Just Reach Out and Touch Someone
Lung transplantation is an accepted therapeutic option for patients who have a number of end-stage pulmonary diseases. In calendar year 1999, the United Network for Organ Sharing reported1 that 877 lung transplants and 49 heart-lung transplants had been performed in the United States alone, with a waiting list of 3,491 persons. During the same time period, > 2,000 transplants were performed worldwide.2 About 76% of lung transplant recipients will survive through the first year, and 56% make it to 3 years. When assessing the efficacy of a given intervention on outcomes for any end-stage organ disease, there is a growing emphasis not only on improvements in survival, but also on the associated health-related quality of life (HRQOL). Incorporating HRQOL and survival has resulted in the generation of quality-adjusted life years (QALY) as a measure of transplantation outcomes.
In the area of lung transplantation, there is a growing body of literature attesting to improvements in patients’ posttransplant HRQOL. To illustrate this growing research effort, we performed a MEDLINE search for the years 1990 through March 2002 using the key words “quality of life” and “lung transplantation,” and we received 197 citations. In 27 of these citations, quality of life (QOL) was the major focus of the study, but in only 11 of the studies was QOL in the pretransplant candidates assessed. In only one of these articles was an intervention implemented to improve a patient’s pretransplant QOL.3 So, while there is an increasing focus on HRQOL posttransplant, there is a relative paucity of data on the pretransplant population, with one lone article looking at an intervention directed at optimizing QOL before lung transplantation. This apparent lack of research into this specific area is likely due to the commonly accepted notion that pulmonary rehabilitation does improve HRQOL. There are many studies attesting to this, specifically in the COPD population. There is, however, a lack of data attesting to the utility of pulmonary rehabilitation in other patient groups.4 Nonetheless, it is likely that most patients who are lung transplant candidates will derive some measure of benefit from pulmonary rehabilitation.