Current Nutrition Practices in Adult Lung Transplantation

Abstract

Nutrition therapy is vital to the overall management of lung transplant recipients. The objective of this review is to outline the current applications of pre- and posttransplant nutrition management of the adult lung transplant recipient. Pretransplant nutrition therapy decisions are based on cause of end-stage lung disease, transplant indications, and pretransplant nutritional status. Maintaining adequate nutrient stores is the major goal of nutrition therapy for patients awaiting transplantation. In the posttransplant course, several gastrointestinal (GI) complications such as gastroesophageal reflux, gastroparesis, and distal intestinal obstruction syndrome complicate nutritional recovery. Long-term nutrition therapy for lung transplant recipients is aimed at management of common comorbid conditions such as obesity, diabetes mellitus, hypertension, osteoporosis, and hyperlipidemia. Lung transplantation outcomes are steadily improving; however, much has yet to be explored to improve the nutrition management of these patients in both the pre- and posttransplantation course.

Reversibility of cachexia after bilateral lung transplantation

“…We paid special attention to the weight gain in CF patients because concomitant symptoms as gastroesophageal reflux, gastroparesis, distal intestinal obstruction syndrome and infections with multi-resistant bacteria contribute here to cachexia [18], and especially death at ICU is associated with low BMI in these patients [10]. Surprisingly, our study proved a weight increase in this subgroup at every time of follow-up, which seems to be better than in patients with other diagnoses.…”

Practical Guidelines: Lung Transplantation in Patients with Cystic Fibrosis

“…A healthy weight should be promoted long before LTX is indicated [40]. This being said, CF patients with end-stage lung disease are at risk of significant weight loss as energy expenditure is increased on one hand (secondary to the increased work of breathing and the chronic bronchopulmonary infection) and optimal calorie uptake is compromised on the other hand (by the exocrine pancreatic insufficiency, a loss of appetite in the context of inflammation/infection, and the respiratory discomfort caused by gastric distension after meals) [44–46]. Relevant nutritional information should be exchanged between dietitians from the referring CF centre and the transplant centre to optimise management.…”

“…Oral diet can usually resume on postoperative day (POD) 1 or 2 if the patient has been extubated swiftly. Oral intake should be increased as tolerated with provision of adequate pancreatic enzyme replacement therapy (PERT) [46, 93]. Appetite generally improves as breathing becomes easier, bowel function normalises, and mobility improves.…”

“…Appetite generally improves as breathing becomes easier, bowel function normalises, and mobility improves. However, anorexia, changes in taste, nausea, vomiting, diarrhoea, or constipation may limit oral intake [46]. These may be due to medical conditions, but a number of the medications used to prevent or treat rejection and infection, including antibiotics and antifungal drugs, can also cause nausea, vomiting, diarrhoea, and changes in taste and affect dietary intake.…”

Optimizing Nutrition Assessment to Create Better Outcomes in Lung Transplant Recipients: A Review of Current Practices

“…distance on 6 minute walk test, and worsened hypoxemia [10,26]. Additionally, these patients are likelier to experience prolonged ICU LOS, days on mechanical ventilation, and increased mortality [9,11,13,27].…”