Improvements in Patient-reported Functioning After Lung Transplant Is Associated With Improved Quality of Life and Survival

Background. Lung transplantation aims to improve health-related quality of life (HRQL) and survival. Although improvements in lung function are associated with these outcomes, the role of physical functioning is less clear. We investigated the association between changes in patient-reported physical functioning and HRQL, chronic lung allograft dysfunction (CLAD), and survival after lung transplantation. Methods. This single-center prospective cohort study analyzed 220 lung transplant recipients who completed a 15-item Lung Transplant-Valued Life Activities (LT-VLA) before and repeatedly after transplantation. HRQL was measured using validated generic, disease-specific, and utility measures. Associations between 0.3-point changes (the minimally important difference) in LT-VLA as time-varying predictors of HRQL, CLAD, and mortality were tested using linear mixed-effects models for HRQL and Cox proportional hazard models with LT-VLA as a time-varying predictor for CLAD and mortality. Mixed-effects models treated time as a categorical variable to account for possible nonlinear changes over time. Models were adjusted for demographics, disease diagnosis, and postoperative lung function as time-varying covariates. Results. Participants were 45% women and 75% White, with a mean age of 56 (±12) y. Each 0.3-point improvement in the LT-VLA was associated with significantly improved HRQL across all measures (adjusted P < 0.01). Each 0.3-point improvement in LT-VLA was associated with a 13% reduced hazard of CLAD (adjusted hazard ratio: 0.87, 95% confidence interval: 0.76-0.99, P = 0.03) and a 19% reduced hazard of mortality (adjusted hazard ratio: 0.81, 95% confidence interval: 0.67-0.95, P = 0.01). Conclusions. Improvements in patient-reported physical functioning after lung transplantation are associated with improved HRQL and a reduced risk of CLAD and death, independent of allograft function. The simplicity of LT-VLA suggests that it could be a valuable monitoring or outcome measure in both clinical and research settings.