Pneumologie 2020; 74(S 01): 13-14
DOI: 10.1055/s-0039-3403084
Freie Vorträge (FV05) – Sektion Pathophysiologie und Aerosolmedizin
Freie Vorträge der Sektion Pathophysiologie und Aerosolmedizin
Georg Thieme Verlag KG Stuttgart · New York

Respiratory muscle and lung function in lung allograft recipients: relation to tumor necrosis factor alpha and association with exercise intolerance

J Spießhöfer
1   Respiratory Physiology Laboratory, Department of Neurology with Institute for Translational Neurology, University Hospital Muenster, Germany
,
M Mohr
2   Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Germany
,
LH Schmidt
3   Medizinische Klinik A, Schwerpunkt Pneumologie, Universitätsklinik Münster
,
M Boentert
4   Department für Neurologie, Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen, Universitätsklinikum Münster
› Author Affiliations
Further Information

Publication History

Publication Date:
28 February 2020 (online)

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    Background: In lung transplant recipients (LTRs) restrictive lung function impairment and respiratory muscle dysfunction may reduce exercise capacity. Pro-inflammatory cytokines such as tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) might mediate this. Therefore, we investigated lung respiratory muscle function as well as circulating pro-inflammatory cytokines and exercise capacity in LTRs.

    Methods: 15 LTRs (6 female, 56 ± 14 years, 63 ± 45 months post-transplantation) and 15 healthy controls matched for age, gender and BMI underwent spirometry, measurement of mouth occlusion pressures, diaphragm ultrasound, and recording of transdiaphragmatic (twPdi) and gastric pressures (twPgas) following magnetic stimulation of the phrenic nerves and the lower thoracic nerve roots. Exercise capacity was quantified using the 6-minute walking distance (6MWD). Plasma IL-6 and TNF-α were measured using enzyme-linked immunosorbent assays.

    Results: Patients had lower values compared with controls for forced vital capacity (FVC; 81 ± 30 vs.109 ± 18% predicted, p = 0.01), maximum expiratory pressure (PEmax; 100 ± 21 vs.127 ± 17 cmH2O, p = 0.04), diaphragm thickening ratio (2.2 ± 0.4 vs.3.0 ± 1.1, p = 0.01) and twPdi (10.4 ± 3.5 vs.17.6 ± 6.7 cmH2O, p = 0.01). In LTRs, elevation of TNF-α was related to lung function (13 ± 3 vs. 11 ± 2 pg/ml in patients with FVC < 80 vs. > 80% predicted) (all p < 0.05) and lung function (forced expiratory volume after 1 second) was closely associated with diaphragm thickening ratio (r = 0.81; p < 0.01) and 6 MWD (r = 0.63; p = 0.02).

    Conclusion: In LTRs, there is marked restrictive lung function impairment and respiratory muscle weakness. This applies to inspiratory muscle weakness with diaphragm dysfunction in particular. Lung function impairment relates to elevated levels of circulating TNF-α and diaphragm dysfunction and is associated with exercise intolerance.


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