Underweight Patients With Cystic Fibrosis Have Acceptable Survival Following Lung Transplantation

Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation

“…(43,44) While low BMI has been associated with increased mortality, CF recipients with BMI <17 kg/m 2 have a survival rate similar to other commonly transplanted patients. (45) Of note, the mechanisms underlying adverse effects of high or low BMI on transplant outcomes are not well understood. Recent data show that BMI is not an accurate surrogate of body composition with ongoing research efforts to better assess and risk stratify transplant candidates.…”

Nutrition management in adults with cystic fibrosis

“…Severe protein‐calorie malnutrition often occurs with advanced CF lung disease, such that patients may require enteral tube feedings to maintain or gain weight. This becomes especially important for lung transplant consideration when transplant centers frequently use lower‐limit cutoffs as relative contraindications to candidacy, 70–72 often a BMI of 17 or 18, although there are recent data suggesting that this practice may be unnecessary as low BMI does not seem to affect lung transplant survival in CF as previously thought 73 …”

“…This becomes especially important for lung transplant consideration when transplant centers frequently use lowerlimit cutoffs as relative contraindications to candidacy, [70][71][72] often a BMI of 17 or 18, although there are recent data suggesting that this practice may be unnecessary as low BMI does not seem to affect lung transplant survival in CF as previously thought. 73 Enteral feeding tubes for nutrition can lead to weight gain and promote the maintenance of lung function, especially for those with severe disease. 69 As previously discussed, RELiZORB may be used in-line with tube feeds when patients are unable to take oral PERT, such as during critical illness and in the immediate postoperative period.…”

Organ Transplantation for Cystic Fibrosis

“…81 A BMI less than 18.5 has been associated with increased mortality both while awaiting lung transplantation and also post-lung transplant. 82 In contrast, a meta-analysis analyzing risk factors for posttransplant mortality did not find that malnutrition was associated with an increased risk of death, 83 and a recent registry review demonstrated that even in patients with CF and a BMI <17, survival was comparable to recipients with pulmonary fibrosis, 84 suggesting that mild malnutrition in itself should not preclude lung transplant referral and listing. The variable practices toward malnutrition and lung transplant candidacy and outcomes may be due to transplant-center experience and to the fact that the majority of patients gain weight following lung transplantation.…”