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Multicenter Study
. 2025 Oct;168(4):943-953.
doi: 10.1016/j.chest.2025.05.021. Epub 2025 May 24.

Pulmonary Rehabilitation Referral Practice Patterns Across Lung Transplantation Centers in the United States: A Multicenter Survey-Based Study

Juan D Deleija  1 , Sadia Z Shah  2 , Jamie Felzer  3 , Xin Tan  4 , Chris Garvey  5 , Thomas W DeCato  6 , Kelly Pennington  7 , Sameep Sehgal  8 , Cassie Kennedy  8 , Anupam Kumar  9
Affiliations
Multicenter Study

Pulmonary Rehabilitation Referral Practice Patterns Across Lung Transplantation Centers in the United States: A Multicenter Survey-Based Study

Juan D Deleija et al. Chest. 2025 Oct.

Abstract

Background: Functional status and frailty are important considerations in lung transplantation (LT) candidacy because of the potential impact on outcomes after LT. Once listed, waitlist duration can be unpredictable, and preservation of functional capacity is critical to prevent deterioration in conditioning. Pulmonary rehabilitation (PR) has been deemed to be a cornerstone of management of chronic lung disease; its role is often emphasized in lung transplantation.

Research question: What are the physician perceptions surrounding PR in LT centers in the United States?

Study design and methods: We used a web-based, cross-sectional, multicenter survey to assess PR referral and utilization practices across different transplantation centers in the United States.

Results: Twenty-seven US LT centers (44%) responded to the survey, with the majority of respondents (63%) being medical directors. Most LT programs perceived a benefit of PR before transplantation being "likely or extremely likely" on waitlist death (66.7%), quality of life (pre-LT, 92.6%; post-LT, 88.9%), and ICU length of stay (88.9%). Lack of access to a nearby PR facility (88.9%), limited insurance coverage (76.9%), and limited number of lifetime sessions (85.1%) were perceived as the most likely or very likely barriers to PR. In terms of post-LT rehabilitation, most patients were likely to receive daily physical therapy in the ICU (77%), inpatient PR (25%), and outpatient PR (61%). Virtual PR was the most preferred alternative (50%).

Interpretation: We found that PR is perceived to have a beneficial effect on pre-LT and post-LT outcomes by most LT programs. The most significant perceived barriers include patient access and payer coverage.

Keywords: frailty; lung transplantation; pulmonary rehabilitation; socioeconomic factor.

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Conflict of interest statement

Financial/Nonfinancial Disclosures None declared.

Figures

None
Graphical abstract
Figure 1
Figure 1
Percent respondents by United Network of Organ Sharing (UNOS) location.
Figure 2
Figure 2
Preconceptions on pulmonary rehabilitation before transplantation.
Figure 3
Figure 3
Barriers for pulmonary rehabilitation before transplantation.
Figure 4
Figure 4
Most common barriers in pulmonary rehabilitation.
Figure 5
Figure 5
Immediate rehabilitation strategies after transplantation.
Figure 6
Figure 6
Patient’s strategies for rehabilitation after transplantation.
See this image and copyright information in PMC

References

    1. Langer D. Rehabilitation in patients before and after lung transplantation. Respiration. 2015;89(5):353–362. - PubMed
    1. Abidi Y., Kovats Z., Bohacs A., et al. Lung transplant rehabilitation: a review. Life. 2023;13(2):506. - PMC - PubMed
    1. Fried L.P., Tangen C.M., Walston J., et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–M157. - PubMed
    1. Wang L., Zhang X., Liu X. Prevalence and clinical impact of frailty in COPD: a systematic review and meta-analysis. BMC Pulm Med. 2023;23(1):164. - PMC - PubMed
    1. Wilson M.E., Vakil A.P., Kandel P., Undavalli C., Dunlay S.M., Kennedy C.C. Pretransplant frailty is associated with decreased survival after lung transplantation. J Heart Lung Transplant. 2016;35(2):173–178. - PubMed

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