Abstract
Cystic fibrosis (CF) remains a major indication for lung transplantation (LTx). To date, no single objective parameter is predictive of survival after LTx. Worsening of nutritional status and rapidly declining lung function are referral criteria found in the ISHLT guidelines. We aimed to determine whether whether the rate of decline in nutritional status and/or lung function prior to LTx was predictive of survival after LTx. We conducted a retrospective cohort study of CF LTx patients in our institution between 1997 and 2018. BMI (body mass index) and FEV1 (forced expiratory volume in 1 second) values 2 year prior to transplant were collected. For each parameter, patients were divided in two groups according to the rate of change in BMI or FEV1 (linear regression slope). Change in time for these parameters were then assessed using mixed-effect models with knots at every 3 months. During the study period, 198 patients underwent a first double LTx. 9 patients were excluded as they had less than 3 observations for either BMI or FEV1. The remaining patients (n=189) were included in the analysis. The mean BMI slopes were -0,06 and +0,08 kg/m2/month for the two BMI groups, while mean FEV1 slopes were-0,53 and +0,09%/monthin the two FEV1 groups. Linear mixed models for each phenotype are shown in Figure 1. Demographic factors, enteral feeding, post-operative complications and 90-day mortality were similar in all groups. Patients experiencing a preoperative BMI decline have worse 10-year survival after LTx (62 vs 69%), while this effect is not apparent when accounting for FEV1 decline. The FEV1 slope alone does not influence 10-year survival after LTx (65 vs 66%). Our results suggest that the BMI trajectory when used as a marker of nutritional status impacts survival after LTx. The FEV1 trajectory does not appear to significantly impact survival after LTx. A larger study is required to validate these results.
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