BackgroundHeart and lung transplant recipients are at a substantially increased risk of cardiovascular disease (CVD). Since both low-fat and Mediterranean diets can reduce CVD in immunocompetent people at high risk, we assessed adherence among thoracic transplant recipients allocated to one or other of these diets for 12 months.MethodsForty-one transplant recipients (20 heart; 21 lung) randomized to a Mediterranean or a low-fat diet for 12 months received diet-specific education at baseline. Adherence was primarily assessed by questionnaire: 14-point Mediterranean diet (score 0–14) and 9-point low-fat diet (score 0–16) respectively, high scores indicating greater adherence. Median scores at baseline, 6 months, 12 months, and 6-weeks post-intervention were compared by dietary group. We further assessed changes in weight, body mass index (BMI) and serum triglycerides from baseline to 12 months as an additional indicator of adherence.ResultsIn those randomized to a Mediterranean diet, median scores increased from 4 (range 1–9) at baseline, to 10 (range 6–14) at 6-months and were maintained at 12 months, and also at 6-weeks post-intervention (median 10, range 6–14). Body weight, BMI and serum triglycerides decreased over the 12-month intervention period (mean weight − 1.8 kg, BMI –0.5 kg/m2, triglycerides − 0.17 mmol/L). In the low-fat diet group, median scores were 11 (range 9–14) at baseline; slightly increased to 12 (range 9–16) at 6 months, and maintained at 12 months and 6 weeks post-intervention (median 12, range 8–15). Mean changes in weight, BMI and triglycerides were − 0.2 kg, 0.0 kg/m2 and − 0.44 mmol/L, respectively.ConclusionsThoracic transplant recipients adhered to Mediterranean and low-fat dietary interventions. The change from baseline eating habits was notable at 6 months; and this change was maintained at 12 months and 6 weeks post-intervention in both Mediterranean diet and low-fat diet groups. Dietary interventions based on comprehensive, well-supported education sessions targeted to both patients and their family members are crucial to success. Such nutritional strategies can help in the management of their substantial CVD risk.Trial registrationThe IRAS trial registry (ISRCTN63500150). Date of registration 27 July 2016. Retrospectively registered.Electronic supplementary materialThe online version of this article (10.1186/s12937-018-0337-y) contains supplementary material, which is available to authorized users.

Gain in weight is common after heart transplantation but the magnitude of usual weight gain and whether this varies by country is unknown. We systematically reviewed all relevant studies to quantify weight change among heart transplant recipients (HTRs) in the years after transplantation and assess variation with geographic location. We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medica Database databases to September 2020. Eligible studies reported adult HTRs’ mean/median weight and/or body mass index (BMI) up to time of transplantation (baseline) and posttransplantation in any language. Weighted mean differences (WMDs) (95% confidence intervals [CIs]) of weight/BMI from baseline to posttransplantation were estimated using a random-effects model. Ten studies met the inclusion criteria. Pooled analysis showed weight gain of 7.1 kg (95% CI, 4.4–9.8 kg) in HTRs 12 months posttransplant, with corresponding BMI increase of 1.69 kg/m2 (95% CI, 0.83–2.55 kg/m2). Greatest weight gain at 12 months posttransplant occurred in US HTRs (WMD weight 10.42 kg, BMI 3.25 kg/m2) and least, in European HTRs (WMD weight 3.10 kg, BMI 0.78 kg/m2). In conclusion, HTRs gain substantial weight in the years after transplantation, but varying widely by geographic location.

Introduction:Recent experimental evidence suggests normothermic machine perfusion of the vascularized composite allograft results in improved preservation compared to static cold storage, with less reperfusion injury in the immediate post-operative period. However, metabolic acidosis is a common feature of vascularized composite allograft perfusion, primarily due to the inability to process metabolic by-products. We evaluated the impact of combined limb-kidney perfusion on markers of metabolic acidosis and inflammation in a porcine model. Methods:Ten paired pig forelimbs were used for this study, grouped as either limb-only (LO, n = 5) perfusion, or limb-kidney (LK, n = 5) perfusion. Infrared thermal imaging was used to determine homogeneity of perfusion. Lactate, bicarbonate, base, pH, and electrolytes, along with an inflammatory profile generated via the quantification of cytokines and cell-free DNA in the perfusate were recorded. Results:The addition of a kidney to a limb perfusion circuit resulted in the rapid stabilization of lactate, bicarbonate, base, and pH. Conversely, the LO This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Background Cardiovascular disease (CVD) is common after cardiothoracic transplantation and causes substantial morbidity. Aims To assess feasibility and potential effectiveness of dietary interventions to reduce CVD risk. Materials and Methods In a pilot intervention, we recruited patients from a tertiary hospital and randomly allocated them to a Mediterranean or low‐fat diet for 12 months. Feasibility was measured by patient participation, retention, and adherence. Changes in weight, body mass index (BMI), heart rate, blood pressure, glucose markers, and blood lipids were assessed using longitudinal generalized estimating equation regression models with 95% confidence intervals. Results Of 56 heart and 60 lung transplant recipients, 52 (45%) consented, 41 were randomized, and 39 (95%) completed the study with good adherence to randomized diets. After 12 months, changes in many risk factors were seen in the Mediterranean and low‐fat‐diet groups, respectively, including mean BMI (–0.5 vs. 0.0 kg/m2), systolic/diastolic blood pressure +0.5/+0.1 vs –4.4/–3.5 mmHg; fasting glucose –0.26 vs –0.27 mmol/L; total cholesterol –0.56 vs –0.40 mmol/L. Changes in BMI and systolic/diastolic blood pressure in 49 eligible patients who did not take part were +0.7 kg/m2 and +2.5/+1.8 mmHg. Discussion Dietary interventions in cardiothoracic transplant patients are feasible and potentially beneficial. Conclusion A definitive nutritional intervention study in these high‐risk patients is warranted.