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Eur J Cardiothorac Surg 2000;17:355-361
© 2000 Elsevier Science NL

Mechanisms of pulmonary transfer factor decline following heart transplantation

^a Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow G31 2ES, UK
^b University Department of Cardiac Surgery, Glasgow Royal Infirmary, Glasgow G31 2ES, UK

Corresponding author. Present address: Department of Medicine, College of Medicine, Sultan Qaboos University, P.O. Box 35, Postal Code 123, Muscat, Sultanate of Oman. Tel.: +968-513-355 (ext. 3404); fax: +968-513-009
e-mail: orawas{at}squ.edu.om

Objective: Although the decline in the pulmonary transfer factor (TL_CO) following heart transplantation is well documented, the causes and mechanisms of this decline remain unknown. The aim of this study was to determine the relative contribution of each of TL_CO components (the diffusing capacity of the alveolar-capillary membrane (D_M), the pulmonary capillary blood volume (V_C) and haemoglobin concentration) to TL_CO reduction in heart transplant recipients. Methods: TL_CO and its components were measured in 75 heart transplant recipients (mean age 48 years, range 19–61) between 6 weeks and 36 months after transplantation using the Roughton and Forster method and the single-breath technique. Results were compared with data from 38 heart transplant candidates (mean age 51 years, range 34–61) and 26 normal subjects (mean age 47 years, range 27–62). Results: The mean percentage predicted TL_CO was reduced in recipients compared to candidates (56.9 and 69.9%, respectively, P<0.001) and both were lower than normal controls (97.7%, P<0.001). The mean percent predicted V_C was also reduced in recipients compared to candidates (52.8% vs. 80.2 (4.2)%, P<0.001) which was also lower than normal subjects (102%, P<0.001). D_M was equally reduced in recipients and candidates (77.7 and 81.4%, respectively, P=0.48) compared to normal subjects (100.0%, P<0.001). Correction for haemoglobin concentration increased TL_CO in recipients to 63.5% (P<0.001), but it remained lower than haemoglobin-corrected TL_CO in candidates (71.1%, P<0.001). In recipients, the intra-capillary resistance (1/V_C) formed 60% of the total resistance to CO transfer (1/TL_CO) compared to 50% in candidates and normal subjects. Conclusions: TL_CO decline following heart transplantation is due to an increase in the intra-capillary resistance, and this appears to be due to a combination of anaemia and reduced pulmonary capillary blood volume, with the diffusing capacity of the alveolar-capillary membrane remaining unchanged.

Key Words: Heart transplantation • Pulmonary function • Pulmonary transfer factor • Alveolar-capillary membrane diffusing capacity • Pulmonary capillary blood volume

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