When the Patient Is Not an “Ideal” Candidate. The Importance of Early Physical Therapy Intervention Pre- and Post–Lung Transplant: A Case Report

Purpose: Each year thousands of patients are placed on lung transplant waiting lists. Despite evidence of the importance of pulmonary rehabilitation programs for this population, minimal literature regarding physical therapy (PT) for the candidate that is admitted to the hospital to await surgery exists. This case report describes a successful rehabilitation approach for this patient population. Case Presentation: A 59-year-old male patient with a diagnosis of idiopathic pulmonary fibrosis was admitted to the intensive care unit to await lung transplant. The inability to manage the patient's high oxygen requirements in his home environment, as well as the progression of his disease, prompted the need for constant medical management in an intensive care setting. His presurgical comorbidities classified him as a less than “ideal” transplant candidate. He received early and frequent PT both pre- and posttransplant, with focus on strengthening and gait training activities to improve his functional capacity. Subjective improvements in quality of life and function after bilateral lung transplant were achieved despite potential for a complicated postoperative course related to his medical history. Conclusion: Early and frequent PT may be important for patients admitted to the intensive care unit while awaiting transplantation and can play an even greater role for the less than “ideal” transplant candidate. The PT interventions can be provided safely for this population in the hospital setting. A rehabilitation approach focused on maximizing a patient's functional capacity with strength and gait training activities may facilitate improved outcomes for lung transplant recipients deemed less than optimal candidates.