Prevalence of Malnutrition and Growth in Children after Lung Transplantation

Abstract

Lung transplantation is the final therapeutic option for children with end-stage lung disease and malnutrition increases risk of mortality post operatively. The purpose of this study was to evaluate nutritional status in children admitted to the intensive care unit (ICU) at the time of lung transplantation (LTx) and somatic growth during the first year thereafter. Methods: Retrospective chart review of patients who underwent lung transplant (1/11-8/14). Nutritional status on admission to the ICU and for the first year after lung transplant were assessed by height for age (HFA: stunting) z-scores according to the WHO/CDC growth charts. Hospital and ICU length of stay (LOS), readmissions, rejection episodes and duration of mechanical ventilation were obtained. Results: Fifty-three children (19 males) were included: age 10.9 years (3.8-16; median (IQR)); Hospital LOS, 21(12-71) days; ICU LOS: 4.2 (3-5) days; duration of mechanical ventilation, 1 (1-2) days. The prevalence of stunting at time of LTx was 69.8%. Patients with cystic fibrosis (CF) (n= 25) had on admission a HFA z-scores of-1.98±1.10 vs-1.03±1.56 (p < 0.05) for non CF patients, respectively. CF patients had higher admission rates and higher incidence of rejection (55% and 67% respectively) compare to non CF patients (44% and 33%). Weight, height, and HFA z-score at LTX and at 12 months were: 29±18, 34±19 kg;122±34,127±32 cm;-1.46±1.46,-2.04±1.40, respectively, all comparisons p < 0.05. There was no association between stunting and longer hospital and ICU LOS and duration of mechanical ventilation. Two patients died during the first year after LTx. Conclusion: Patients with cystic fibrosis had a higher prevalence of stunting compared to non cystic fibrosis patients, higher rates of readmissions, and more episodes of rejection. Patients had an improvement on anthropometric variables with increased height after LTX, but at a lower than expected rate for age leading to worsening stunting.