Nutritional Requirements of Lung Transplant Recipients: Challenges and Considerations

Abstract

An optimal nutritional status is associated with better post-transplant outcomes and survival. Post-lung transplant nutrition management is however particularly challenging as lung recipients represent a very heterogeneous group of patients in terms of age, underlying diseases, weight status and presence of comorbidities. Furthermore, the post-transplant period encompasses several stages characterized by physiological and pathophysiological changes that affect nutritional status of patients and necessitate tailored nutrition management. We provide an overview of the current state of knowledge regarding nutritional requirements in the post-lung transplant period from the immediate post-operative phase to long-term follow-up. In the immediate post-transplantation phase, the high doses of immunosuppressants and corticosteroids, the goal of maintaining hemodynamic stability, the presence of a catabolic state, and the wound healing process increase nutritional demands and lead to metabolic perturbations that necessitate nutritional interventions. As time from transplantation increases, complications such as obesity, osteoporosis, cancer, diabetes, and kidney disease, may develop and require adjustments to nutrition management. Until specific nutritional guidelines for lung recipients are elaborated, recommendations regarding nutrient requirements are formulated to provide guidance for clinicians caring for these patients. Finally, the management of recipients with special considerations is also briefly addressed.

Evaluation of Malnutrition Risk in Lung Transplant Candidates Using the Nutritional Risk Index

“…To our knowledge, there are no standardized guidelines to combat malnutrition in chronic lung disease, but general recommendations aim to offset weight loss through nutritional recommendations with the goal of preventing any further weight loss. 44 - 46 We observed that 86% of LTx candidates were able to maintain or gain weight (≥5%) during the pretransplant period with nutritional counseling, but the change in weight on average was minimal as in other studies. 24 Given that nutritional counseling is standard of care at our center, we are unable to evaluate the degree of weight loss that may have ensued without nutritional care.…”

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

“…90 Those with BMI >30 kg/m 2 and obese patients who were unable to lose weight prior to transplant had worse outcomes. 91 Posttransplant nutritional management challenges in these highly catabolic patients were described by Jomphe et al 92 Active casual alcohol use prevalence was about 1 in 3 prior to transplantation and was associated with a 300% increase in mechanical ventilation time and ICU stay and a 150% increase in hospital stay, but mortality and graft function outcomes were not statistically different. 93 E-cigarette use increased in this population.…”

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

“…Given that this area of medical science is young and developing, expert opinion has been the basis of much of the criteria available [4].…”