The time course of pulmonary transfer factor changes following heart transplantation

O. A. Al-Rawas*, R. Carter, R. D. Stevenson, S. K. Naik, D. J. Wheatley

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


Objective: The pulmonary transfer factor for carbon monoxide (TL(CO)) has been reported to decline following heart transplantation, but the time course of this decline is not well documented. The aim of this study was to define the longitudinal changes in TL(CO) after heart transplantation. Methods: Single breath TL(CO), lung volumes and expiratory flow rates were prospectively measured in 57 patients (mean age 49 years, range 19-61) before and at least once after heart transplantation. Thirty seven of the 57 patients had four post-transplant assessments which were performed at 6 weeks, 3, 6 and 12 months in 26 patients and at 12, 18, 24 and 36 months in 11 patients. Results were compared with data from 28 normal subjects (mean age 40 years, range 19-61). Results: Before transplantation there was a mild impairment of lung volumes and expiratory flow rates. At 6 weeks after transplantation, there was a further reduction in the forced expiratory volume in one second, forced vital capacity, residual volume and total lung capacity, but all of these increased in the subsequent measurements to exceed their pre-transplant values at about 1 year after transplantation. Haemoglobin-corrected TL(CO) was also reduced before transplantation compared to normal controls (74.3% and 98.6% of predicted respectively, P < 0.001). Although TL(CO) per unit alveolar volume (K(CO)) was relatively preserved in heart transplant candidates, it was still significantly lower than that of normal controls (92.6% and 105.3% of predicted respectively, P < 0.05). After transplantation, mean haemoglobin-corrected TL(CO) and K(CO) declined by 12% and 20% of predicted respectively) with the majority of patients having reductions greater than 10% of predicted. The decline in TL(CO) and K(CO) was evident at 6 weeks after transplantation with no further changes in the subsequent measurements. Conclusions: TL(CO) is reduced in heart transplant candidates and declines further after heart transplantation despite improvement in lung volumes and airway function. The early and non- progressive nature of TL(CO) decline suggests an aetiology exerting its effect on TL(CO) within the first 6 weeks after transplantation.

Original languageEnglish
Pages (from-to)471-479
Number of pages9
JournalEuropean Journal of Cardio-thoracic Surgery
Issue number3
Publication statusPublished - Sept 1997


  • Cardiac surgery
  • Heart transplantation
  • Pulmonary diffusing capacity
  • Pulmonary function
  • Pulmonary transfer factor

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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