Evaluation of nutritional status in lung transplant recipients and its correlation with post-transplant short-term prognosis: a retrospective study

Abstract

Background: Lung transplantation is an effective treatment for saving the lives of patients with end-stage lung disease (ESLD). Lung transplant-related morbidity and mortality has significantly higher than other solid organ transplants. Among the pre-transplant variables that affect the survival rate after transplantation, nutritional status are associated with poor survival rate. In order to provide basis for formulating nutritional evaluations for lung transplant recipients in the future, we retrospectively analyzed the nutritional status of lung transplantation recipients and explore its correlation with the short-term prognosis.Methods: This retrospective cohort study included patients who were hospitalized in 2020 and underwent lung transplant surgery at Shanghai Pulmonary Hospital. Inclusion criteria: (I) aged ≥18 years; (II) have been diagnosed with ESLD; (III) have received no other effective treatments; (IV) have undergone a transplantation at Shanghai Pulmonary Hospital. We summarized the patients' general information, including their sex, age, major lung disease etc. And we also collected nutritional status, such as Nutritional Risk Screening 2002 (NRS 2002), subjective global assessment (SGA) and nutritionalrelated indicators, including albumin, prealbumin, retinol-binding protein etc. before surgery and 1 month after surgery. In addition, we collected postoperative drainage volume, length of stay in intensive care unit (ICU), total hospital days, and hospitalization costs to evaluate the short-term prognosis.Results: A total of 33 lung transplant recipients were included and successfully underwent surgery. Of the patients, 16 had preoperative NRS 2002 scores ≥3 points, of whom 7 were assessed by the SGA as having mild-moderate malnutrition and 9 as having severe malnutrition. The albumin indexes of these 16 patients, including their prealbumin, and calcium contents, were significantly lower than those of patients with NRS scores <3. Patients with preoperative NRS scores ≥3 had higher drainage volumes, longer hospitalization times, and higher total hospitalization costs than those with NRS scores <3.Conclusions: Lung transplant recipients have a higher incidence of nutritional risk and malnutrition, which seriously affects their short-term prognosis. Thus, in clinical practice, lung transplant recipients should be screened for nutritional risk and provided preoperative nutritional support to maintain a good preoperative status to improve their prognosis.

Malnutrition in solid organ transplant patients: A review of the literature

“…55,57 Altered gastrointestinal conditions such as gastroesophageal reflux disease, dysphagia, ineffective esophagus, gastroparesis, and restrictive scleroderma also exacerbate the risk for malnutrition. 4,[57][58] Severe malnutrition, low BMI, and gastrointestinal conditions that increase the risk for reflux, aspiration, and rejection may require prolonged periods of nothing by month (NPO)…”

“…Results from a 2022 study indicated that patients with high nutrition risk had significantly increased post-op chest tube drainage 24-h post-transplant, significantly increased ICU LOS, and significantly higher hospital costs (p < .05). 4 A 2020 study found that non-CF patients with high malnutrition risk were more likely to have low BMI and shorter 6-min walk distance. There was no association with ICU admission in the pre-transplant period, delisting, or mortality.…”

“…The development of malnutrition in patients with lung disease is multifactorial including poor appetite, increased work of breathing while eating, hypermetabolism, frequent exacerbations, decreased exercise tolerance, decrease in fat‐free mass, inflammation, and dysgeusia 55,57 . Altered gastrointestinal conditions such as gastroesophageal reflux disease, dysphagia, ineffective esophagus, gastroparesis, and restrictive scleroderma also exacerbate the risk for malnutrition 4,57–58 . Severe malnutrition, low BMI, and gastrointestinal conditions that increase the risk for reflux, aspiration, and rejection may require prolonged periods of nothing by month (NPO) and enteral nutrition pre and/or post‐transplant, further compromising nutrition status.…”

“…Additionally, three retrospective cohort studies used the NRI to determine nutritional risk for patients who received lung transplantation. Results from a 2022 study indicated that patients with high nutrition risk had significantly increased post‐op chest tube drainage 24‐h post‐transplant, significantly increased ICU LOS, and significantly higher hospital costs ( p < .05) 4 . A 2020 study found that non‐CF patients with high malnutrition risk were more likely to have low BMI and shorter 6‐min walk distance.…”

“…There is no single, universal tool to diagnose malnutrition, though the most commonly used tools are the Subjective Global Assessment (SGA), Global Leadership Initiative on Malnutrition (GLIM), and the Adult Malnutrition Criteria (AMC) recognized by the Academy of Nutrition and Dietetics (AND) and the American Society for Parenteral and Enteral Nutrition (ASPEN) 1–3 . Other research studies use screening tools such as the Nutritional Risk Index (NRI) or values such as albumin or body mass index (BMI) to determine malnutrition risk in solid organ transplant patients 4–12 . Research using the AND/ASPEN AMC, the widely accepted malnutrition tool in the US used by RDNs since 2012, is lacking among solid organ transplant patient populations and is needed to quantify risks and costs associated with malnutrition given the high prevalence of malnutrition in end‐stage organ diseases.…”