Prevalence and consequences of nutritional depletion in lung transplant candidates

Abstract

Nutritional status was studied in lung transplant (LT) candidates. The hypotheses were that nutritional depletion was highly prevalent and lean body mass depletion was a risk factor for a higher mortality both before and after LT.Of 78 consecutive patients listed for LT, 16 (21%) died while on the waiting list, eight (10%) were alive awaiting LT, and 54 (69%) received a graft. Mean age was 42.3 4.4 (mean SD). Thirty-eight per cent had a diagnosis of bronchiectasis or cystic fibrosis (BRO/CF), 33% of emphysema, 20% of idiopathic pulmonary fibrosis (IPF) and 8% of primary pulmonary hypertension. Body mass index (BMI) was 20.4 4.3 kg . m 2 , weight was 87.9 16.6% of ideal body weight (IBW).Patients were classed into four nutritional groups according to IBW and creatinine height index (CHI): I: weight <90% IBW and CHI <60% of predicted (28% of cases); II: weight <90% IBW and CHI $60% (27%); III: weight $90% IBW and CHI <60% (17%); IV: weight $90% IBW and CHI $60% (28%). Overall, 72% were depleted corresponding to groups I, II and III. Lean body mass depletion occurred despite normal weight in 17% of the cases (group III). Subjects with BRO/CF were mostly in groups I, II, III whereas IPF were concentrated in group III. Lean body mass depletion was associated with more severe hypoxaemia, reduced 6-minute walking distance and a higher mortality while awaiting. After LT, duration of mechanical ventilation, time spent in intensive care unit (ICU) was related to initial body composition. Survival after LT was lowest in group III.To conclude, nutritional depletion in lung transplant candidates is highly prevalent and should be more precisely assessed with a special reference to lean body mass since it has specific consequences both while awaiting and after lung transplant. Attempts should be made to increase lean body mass before lung transplant. Eur Respir J 2000; 16: 1050±1055.

Reversibility of cachexia after bilateral lung transplantation

“…This reversibility of cachexia is of vital importance for patients, because a BMI b 21 kg/m 2 is associated with higher mortality pre [1][2][3][4] and after LTx [5][6][7]. The majority of former studies focused on obesity and proved also a correlation between higher BMI and mortality [6].…”

“…Cachexia is one of the terminating syndromes in pulmonary disease [1][2][3][4], and malnutrited or cachectic patients have an increased mortality even after bilateral lung transplantation (LTx) [5][6][7]. Especially in patients with cystic fibrosis (CF), a low body mass index (BMI) is associated with higher mortality both before [8,9] and after LTx [10].…”

Effect of Preoperative Pulmonary Artery Pressure on Early Survival After Lung Transplantation for Idiopathic Pulmonary Fibrosis

“…For instance, recipient risk factors previously reported to influence posttransplant outcome such as nutritional status were not included. [37][38][39][40] The ISHLT registry PA pressures are those from the time of listing. It is unclear whether these pressures are reflective of those at the time of surgery.…”

Recommendations on the use of exercise testing in clinical practice

“…low BMI) and recurrent infections of the respiratory tract with polyresistant pathogens (e.g. Pseudomonas spp., Burkholderia cepacia) [203][204][205][206].…”