Post-Transplant Metabolomics Profiles in Patients Undergoing Lung Transplantation

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<h3>Purpose</h3> Optimal nutrition is recognized as an essential component to successful outcomes for post procedure recovery after a major cardio-thoracic procedure. We developed a unique multi-modal rehabilitation program that combines physical therapy protocol with neuromuscular electric stimulation (NMES) and protein supplementation to achieve improved functional outcomes for advanced lung disease patients requiring transplantation <h3>Methods</h3> The patients were randomized to either the treatment arm (n=5) or usual care (n=6) 72 hours after the transplant. Both groups of patients underwent an initial global assessment of functional capabilities and blood metabolomic profile evaluation 72 hours post-transplantation. Patients in the treatment arm received additional physical therapy plus NMES (10 days) and nutrition supplementation with essential amino acids (3 times/day) during hospital recovery. Follow up metabolomic profile analysis was performed on 14 days and 3-month post-transplant plasma samples. <h3>Results</h3> Compared to the standard of care group, the treatment group decreased average time of intubation (1.6 vs 2.16 days), decreased average ICU length of stay (5.80 vs 8.67 days) and decreased average hospital length of stay (16.8 vs 19.5 days). The treatment group had increased hypotaurine levels indicating a cytoprotective anti-oxidant effect against free radicals and tissue damage. Preliminary results comparing hypotaurine levels at 72 hours,14 days and 3 month in the treatment group (T-72 hr T-14 days, T-3 months) compared to control group (C-72 hr C-14 days, C-3 months) are presented in figure 1. <h3>Conclusion</h3> Defining the role of metabolomics in post-transplant monitoring is still in its early stages. We intend to use the data obtained from this pilot study to develop a larger, randomized interventional trial evaluating the effects of an intense multimodal rehabilitation program on improving post-operative outcomes and defining blood biomarkers of muscle atrophy during ICU stay after lung transplantation.