Postoperative, Inpatient Rehabilitation after Lung Transplant Evaluation (PIRATE): A Feasibility Randomized Controlled Trial

Purpose Lung transplant (LTx) recipients experience low levels of physical capacity and exercise participation. Physical therapists deliver postoperative rehabilitation programs for safe hospital discharge and community ambulation. Mixed outcomes in trials of intensive, acute rehabilitation in other populations, and a paucity of LTx evidence hinders clinical decision making. We aimed to compare the feasibility, safety, and efficacy of intensive versus standard acute physical rehabilitation following LTx. Methods This randomized controlled feasibility trial recruited 40 adult, bilateral sequential LTx recipients, stratified by age ( Results Group split was 19 (standard) and 21 (intensive). Median age was 61 years {range 18-70}; LTx waitlist time was 85 days [IQR 35-187]. Indication for LTx was primarily interstitial lung disease (40%) and chronic obstructive pulmonary disease (32.5%). Participants first mobilized on median day 2 [IQR 2-3]. Median randomization occurred on day 4 [3-5]. Both groups received a median of 10 [7-14] occasions of routine care post-randomization over a mean (SD) inpatient length of stay of 22.65 (9.10) days. Individually, a median of 9 [IQR 6-18] intensive interventions were attempted, with 1 [0-2] (11%) being missed, at an overall success of 86%. The most common barrier was medical procedures/investigations at 67%. No intervention-related AEs were reported. There were no between-group differences in secondary outcome measures (6MWD mean difference (95%CI) 39.38 (-28.39, 106.95) 3-week; 34.16 (-49.03, 117.35) 10-week, both favoring standard). Conclusion Acute, intensive physical rehabilitation was safe and feasible post-LTx. Definitive trials should assess long-term impact on physical function, exercise participation, or quality of life.