Impact of Malnutrition and Interventions on Patients Receiving Heart Transplant

Karim, Adham; Aljammal, M.; Panhwar, Muhammad Siyab; Kalra, Ankur

doi:10.1016/j.healun.2020.01.556

Cited by 4 publications

(6 citation statements)

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“…Overall, missing data were <2% for all variables so no additional analyses were required. Despite this robust data on more than 1000 combined heart‐kidney recipients, we cannot adjust for factors such as frailty and malnutrition that may contribute to the association between dialysis duration and mortality 15,16 . Ideally, we would have further analyzed the severity of chronic kidney disease in patients who had not started dialysis.…”

Section: Discussionmentioning

confidence: 99%

Impact of diabetes and chronic dialysis on post‐transplant survival in combined heart‐kidney transplant recipients

Parekh

Lam

Chau

et al. 2021

Clinical Transplantation

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Growing research supports an increased survival benefit of combined heart and kidney transplantation in patients with both heart and renal failure. As a result, the frequency of these combined transplants continues to increase. Despite this trend, little has been done to quantify the impact of chronic illness in this population. We identified adult recipients of combined heart-kidney transplant from the Scientific Registry of Transplant Recipients (SRTR) database between 2005 and 2018. We focused on renal disease secondary to diabetes and duration of dialysis as markers of chronic illness. The primary outcome was post-transplant mortality. Our final multivariable Cox proportional hazard model found that diabetes-associated renal disease (HR 1.57, 95% CI 1.14-2.15, p = .01) and dialysis duration (HR 1.08, 95% CI 1.01-1.15, p = .02) were significant predictors of post-transplant mortality. Given the significant impact of dialysis duration and renal disease secondary to diabetes mellitus, these chronically ill patients should be closely examined for conditions such as peripheral vascular disease and frailty, which have been shown to affect mortality in heart transplant recipients and are prevalent in the chronic dialysis population.

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Section: Discussionmentioning

confidence: 99%

Impact of diabetes and chronic dialysis on post‐transplant survival in combined heart‐kidney transplant recipients

Parekh

Lam

Chau

et al. 2021

Clinical Transplantation

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“…21,22 Nutrition supplementation in these patients may be linked to reduced rates of in-hospital mortality and sepsis. 22 Furthermore, any weight loss during the first 3 months after transplant in these patients was associated with worse 5-year survival rate. 23 These outcome data support the practice of promptly starting preoperative nutrition support in patients who are at nutrition risk.…”

Section: Heart Transplantationmentioning

confidence: 99%

“…Fluid retention and edema may skew nutrition assessment criteria typically used for the diagnosis of malnutrition, such as weight changes and anthropometric measurements. Pretransplant malnutrition in heart transplant recipients is associated with increased rates of infectious complications, in‐hospital mortality, sepsis, and acute kidney injury requiring dialysis 21,22 . Nutrition supplementation in these patients may be linked to reduced rates of in‐hospital mortality and sepsis 22 .…”

Section: Nutrition Factors Associated With Risks For Negative Postope...mentioning

confidence: 99%

“…Pretransplant malnutrition in heart transplant recipients is associated with increased rates of infectious complications, in‐hospital mortality, sepsis, and acute kidney injury requiring dialysis 21,22 . Nutrition supplementation in these patients may be linked to reduced rates of in‐hospital mortality and sepsis 22 . Furthermore, any weight loss during the first 3 months after transplant in these patients was associated with worse 5‐year survival rate 23 .…”

Section: Nutrition Factors Associated With Risks For Negative Postope...mentioning

confidence: 99%

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Nutrition support management of organ transplant recipients in the acute posttransplant phase

Hahn,

Wood,

Hasse

2023

Nut in Clin Prac

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Patients who undergo solid organ transplant can have an extensive and challenging postoperative course. The chronicity of the disease state prior to transplant in combination with transplant‐specific complications and immunosuppressant medications can lead to distinct challenges that are not observed in other critically ill patients. Although the manifestation of posttransplant complications may be specific to the organ being transplanted, there are common transplant challenges that affect nutrition therapy in these patients. Effects of malnutrition, metabolic aberrations, and posttransplant organ dysfunction should be considered when developing a nutrition care plan for patients in the immediate posttransplant phase. This article addresses the various complications that can arise in the immediate posttransplant phase among patients undergoing solid organ transplant and the appropriate nutrition interventions or considerations for this specialized patient population.

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“…Chief among these factors is appropriate patient selection, 1 whereby patients with marginal physiologic reserve, severe frailty, or advanced degrees of malnutrition are not suitable candidates for transplantation unless these characteristics can be optimized. 2,3 Unfortunately, little data exist on precisely which objective besides assessments are most accurate and predictive of subsequent adverse events. Assessment of frailty or nutrition status is heterogeneously practiced across centers and still largely predicated on invalid or crude parameters, such as serum albumin levels or body mass index (BMI).…”

Section: Introductionmentioning

confidence: 99%

Bioimpedance Spectroscopy in Heart Transplantation: Posttransplant Changes in Body Composition and Effects in Outcomes

et al. 2023

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Background. Bioimpedance spectroscopy yields measurements of fat-free mass, fat mass, phase angle, and other measures. Bioimpedance spectroscopy has been validated as a preoperative assessment tool in cardiac surgical studies, in which low phase angle predicted morbidity and mortality. No studies have evaluated bioimpedance spectroscopy following heart transplantation. Methods. We evaluated body composition, nutrition status (Subjective Global Assessment, body mass index, midarm muscle circumference, and triceps skinfolds), and functional status (handgrip strength and 6-min walk test) in 60 adults. Body composition measurements via a 256-frequency bioimpedance spectroscopy device included fat and fat-free mass as well as phase angle calculated at 50 kHz. Testing was completed at baseline and 1, 3, 6, and 12 mo following heart transplantation. Mortality and hospital readmissions were analyzed. Results. Phase angle and fat mass increased while fat-free mass decreased; grip strength and 6-min walk test improved after transplantation (all P < 0.001). Improvement in phase angle in the first month postoperatively was associated with reduced risk of readmission. Low perioperative and 1-mo phase angles were associated with prolonged posttransplant length of stay (median: 13 versus 10 d, P = 0.03), increased infection-related readmissions (40% versus 5%, P = 0.001), and increased 4-y mortality (30% versus 5%, P = 0.01). Conclusions. Phase angle, grip strength, and 6-min walk test distance improved after heart transplantation. Low phase angle appears to be associated with suboptimal outcomes and may be a feasible and affordable method to predict outcomes. Further research should ascertain whether preoperative phase angle can predict outcomes.

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Impact of Malnutrition and Interventions on Patients Receiving Heart Transplant

Cited by 4 publications

References 0 publications

Impact of diabetes and chronic dialysis on post‐transplant survival in combined heart‐kidney transplant recipients

Impact of diabetes and chronic dialysis on post‐transplant survival in combined heart‐kidney transplant recipients

Nutrition support management of organ transplant recipients in the acute posttransplant phase

Bioimpedance Spectroscopy in Heart Transplantation: Posttransplant Changes in Body Composition and Effects in Outcomes

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