Outcomes of multidisciplinary inpatient rehabilitation following heart and/or lung transplantation

Heart and lung transplantation is becoming a more common treatment option for patients with end-stage cardiopulmonary disease. Both the incidence and survival of transplant operations are increasing, resulting in heightened interest in optimising long-term patient outcomes, functional ability and quality-of-life following transplant. Specialist rehabilitation can help to promote recovery and enhance functional ability following transplant surgery, particularly for frail and debilitated patients. A retrospective file audit was conducted to review all admissions for multidisciplinary inpatient rehabilitation following heart and/or lung transplant between 2009–2016, at St-Vincent's Hospital Sydney, Australia. This is the largest and oldest heart and lung transplant centre in Australia. Between 2009–2016, 603 heart/lung transplant surgeries were performed at St-Vincent's Hospital Sydney. Of these patients, 116 (19.2%) were admitted for inpatient rehabilitation: 49 heart, 65 lung and 2 combined heart-lung recipients. The rehabilitation cohort was comprised of 63 men and 53 women, mean age 53.4 ± 12.2 years. Average rehabilitation length-of-stay was 26.9 ± 2.0 days. Functional Independence Measure (FIM) scores improved significantly with rehabilitation, from 79.8 ± 1.9 on admission to 101.8 ± 2.8 at discharge (P < 0.001), resulting in a mean FIM efficiency of 0.9 ± 0.1. Physical measures of mobility and balance also showed significant improvements, including the 6 Minute Walk Test (P < 0.001), Timed Up and Go (P < 0.001) and Berg Balance Scale (P < 0.001); 33.6% of admissions were interrupted by an acute medical complication, however this did not prevent completion of rehabilitation or attainment of functional gains for the majority of cases. One hundred and nine patients (94%) were discharged to a private residence following rehabilitation, 2 were transferred to a regional hospital and 5 died in hospital. Multidisciplinary inpatient rehabilitation resulted in significant functional improvements for debilitated patients following heart and/or lung transplantation. These results support a role for specialist inpatient rehabilitation in optimising functional capacity and independence post-transplant.