Malnutrition in Lung Transplant Recipients: Weighing the Outcomes

Abstract

<h3>Purpose</h3> Malnutrition negatively impacts outcomes post-lung transplantation. Therefore, nutrition status is routinely considered in the selection criteria for lung transplant candidates. Malnourishment is often present in patients with end-stage lung disease, and unfortunately, it cannot always be resolved before surgery. The impact of malnutrition on lung transplant outcomes has been assessed in the literature using a variety of different methods. However, the standard of care used by nutrition experts and Registered Dietitians, the Academy of Nutrition and Dietetics/American Society of Parenteral and Enteral Nutrition (AND/ASPEN) criteria, has not been considered. Here we investigated how malnutrition identified by these criteria can affect outcomes of lung transplant recipients. <h3>Methods</h3> We retrospectively assessed twenty-two patients who met criteria for moderate or severe malnutrition at the time of transplant using the AND/ASPEN criteria between Jan 1st 2018 and June 1st 2021. We used a control group of twenty-two non-malnourished patients that had similar age and transplant type (single vs bilateral) and compared several different outcome measures using a Kruskal-Wallis test. The data was analyzed using R 4.0.2 (The R Foundation for Statistical Computing http://www.R-project.org). <h3>Results</h3> The average age of both groups was 54.4 years, and 50% of the population was female. We found a significant increase in length of stay (LOS) for the malnourished group (p=0.045) as well as an increased need for return to the intensive care unit (ICU) within 60 days of transplant (p=0.021). Interestingly, no differences were found between the two groups regarding days on a ventilator, days in ICU, the number of rejections in the first six months, or the need for acute inpatient rehabilitation (AIR) following the transplant admission. <h3>Conclusion</h3> Malnutrition identified by AND/ASPEN criteria does seem to impact outcomes following lung transplant, specifically overall LOS and the need for return to ICU within 60 days of transplant. However, there were no significant differences with days on a ventilator, days in ICU, number of rejections in the first 6 months, or need for AIR after transplant. If possible, malnutrition should be improved before lung transplantation. Larger studies are needed to better understand the impact of malnutrition on outcomes after lung transplant.