Impact of preheart transplant carbon monoxide diffusing capacity testing on post-transplant survival and pulmonary outcomes

The relationship between carbon monoxide diffusing capacity (DLCO) measurement in patients being evaluated for heart transplantation is poorly understood. We collected pretransplant pulmonary function testing (PFT) data on 157 transplant recipients over a 10-year span. Due to a few common reasons such as intensive care unit hospitalization, only 47% of candidates underwent DLCO measurement. However, there were no differences in outcomes regardless of whether or not the test was available to guide candidate selection. No PFT value correlated with pulmonary complications and only forced expiratory volume in 1 second correlated with survival. We conclude that in subjects otherwise eligible for heart transplantation, DLCO measurement carries no significant discriminatory power. Furthermore, due to extensive variability in utilization, arguments on the grounds of equity could be made to eliminate such testing.