The Impact of Waiting List BMI Changes on the Short-term Outcomes of Lung Transplantation

Jomphe, Valérie; Mailhot, Geneviève; Damphousse, Véronic; Tahir, Muhammad-Ramzan; Receveur, Olivier; Poirier, Charles; Ferraro, Pasquale

doi:10.1097/tp.0000000000001919

Cited by 18 publications

(15 citation statements)

References 48 publications

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“…Interestingly, after censoring deaths in the year following transplant, survival differences between BMI categories were no longer significant, suggesting that such differences were likely driven by events occurring in the first year after transplant, an observation supported by Lederer et al, who showed that obesity was an independent risk factor for primary lung graft dysfunction [ 17 ]. While the link between high pre-transplant BMI and post-transplant survival appears well evidenced [ 3 , 18 ], this association is much less robust among underweight recipients with reports of no effects [ 19 , 20 ], trends towards increased mortality [ 15 , 21 ] and significant impact on mortality [ 16 , 22 , 23 , 24 ]. Of note, the association between low BMI and increased mortality was mainly seen in the largest cohort studies [ 16 , 22 , 24 ] where it was sometimes restricted to specific subgroups such as underweight recipients with COPD [ 22 ] or manifested not until 1 year after transplant [ 16 ], thereby suggesting different timing and mechanisms for increased mortality in underweight vs. overweight/obese patients.…”

Section: Nutritional Status Of Lung Transplant Recipientsmentioning

confidence: 99%

Nutritional Requirements of Lung Transplant Recipients: Challenges and Considerations

2018

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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.

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Section: Nutritional Status Of Lung Transplant Recipientsmentioning

confidence: 99%

Nutritional Requirements of Lung Transplant Recipients: Challenges and Considerations

2018

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“…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.…”

Section: Lung Transplantationmentioning

confidence: 97%

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

Tawil

Adams

Nicoara

et al. 2019

Semin Cardiothorac Vasc Anesth

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Publications of note from 2018 are reviewed for the cardiothoracic transplant anesthesiologist. Strategies to expand the availability of donor organs were highlighted, including improved donor management, accumulating experience with increased-risk donors, ex vivo perfusion techniques, and donation after cardiac death. A number of reports examined posttransplant outcomes, including outcomes other than mortality, with new data-driven risk models. Use of extracorporeal support in cardiothoracic transplantation was a prominent theme. Major changes in adult heart allocation criteria were implemented, aiming to improve objectivity and transparency in the listing process. Frailty and prehabilitation emerged as targets of comprehensive perioperative risk mitigation programs.

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“…With regards the effects of obesity, several studies have demonstrated that a healthy body mass index (BMI) is a predictor of success in lung transplantation . High BMI is associated with a greater incidence of post‐transplant mortality , an increased risk of developing new‐onset diabetes after transplant , and has a negative impact on post‐transplant functional status and quality of life .…”

Section: Review Of the Literaturementioning

confidence: 99%

Elderly patients with multiple comorbidities: insights from the bedside to the bench and programmatic directions for this new challenge in lung transplantation

Shigemura

Toyoda

2019

Transpl Int

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Summary In aging populations, many patients have multiple diseases characterized by acceleration of the aging process including cardiovascular diseases, metabolic diseases, and chronic kidney disease. Remarkable progress in minimally invasive, interventional therapies, such as percutaneous coronary intervention and transcatheter aortic valve replacement has enabled patients who were previously not transplant candidates because of co‐existing problems to become potentially viable candidates for lung transplantation. Recently, we have observed an outstanding and steady increase in patients older 70 years of age with multiple comorbidities who are referred to our high‐volume center as potential candidates for lung transplantation. However, the impact of diseases characterized by an accelerated aging process and their treatments on transplant outcomes remains unclear. This review aims to highlight these challenges in the current era of lung transplantation, review the prior literature, and discuss future directions with a multidisciplinary view including translational research, transplant medicine, and surgery, as well as from a programmatic and administrative standpoint.

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The Impact of Waiting List BMI Changes on the Short-term Outcomes of Lung Transplantation

Abstract: Our results suggest that obese candidates with an unfavorable pretransplant BMI evolution are at greater risk of worse post-LTx outcomes.

Cited by 18 publications

References 48 publications

Nutritional Requirements of Lung Transplant Recipients: Challenges and Considerations

Nutritional Requirements of Lung Transplant Recipients: Challenges and Considerations

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

Elderly patients with multiple comorbidities: insights from the bedside to the bench and programmatic directions for this new challenge in lung transplantation

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