The Effects of Early Postoperative Nutrition Support on Enhanced Recovery After Lung Transplantation

Abstract

<h3>Purpose</h3> There is currently no established guideline for nutritional management after lung transplantation (LT). Therefore, we have developed and introduced a protocol on early post-transplant nutrition, and verified the effectiveness of the protocol in improving nutrition-related outcomes. <h3>Methods</h3> Among 50 consecutive patients ≥18 years undergoing LT (7 from living donors) from January 2019 to April 2021 in our institution, the protocol had been applied in 22 patients since March 2020. The goal of our protocol was to start enteral nutrition or central parenteral nutrition within 48 hours after LT and we set targets of energy and protein amount as 25 kcal and 1 g per kg of ideal body weight a day by day 7. Nutritional sufficiency on day 7 and postoperative changes in body weight and muscle mass for 3 months after LT were retrospectively compared between the pre- and the post-protocol groups. Muscle mass was assessed by cross-sectional areas of the erector spinae muscles, which was evaluated using computed tomography. <h3>Results</h3> Regarding perioperative factors, there were no significant differences between two groups, while intraoperative extracorporeal circulation was more frequently used in the post-group compared to the pre-group (95% vs 64%, <i>p</i>=0.014). The number of cases in which tube feeding and central parenteral nutrition were started within 3 days after LT was significantly larger in the post-group than that in the pre-group (45% vs 7%, <i>p</i>=0.002; and 82% vs 29%, <i>p</i><0.001, respectively). Only 5 patients of the pre-group, who were extubated on day 2, started oral intake within 3 days after LT. The sufficiency rates of energy and protein on day 7 were significantly better in the post-group, compared to the pre-group (84% vs 69%, <i>p</i>=0.011; and 87% vs 74%, <i>p</i>=0.017, respectively). Body weight loss at 3 months after LT was more suppressed in the post-group than that in the pre-group (-0.5 kg vs -4.4 kg, <i>p</i>=0.034). The muscle mass decreased 2 weeks after LT in both groups (-14% in the post-group vs -16% in the pre-group, <i>p</i> = 0.105), while the muscle loss at 3 months after LT was significantly suppressed in the post-group than that in the pre-group (-5% vs -12%, <i>p</i>=0.034). <h3>Conclusion</h3> Although the target sufficiency rates had been incompletely achieved yet after the protocol was introduced, early nutrition support after LT was positively associated with the suppression of weight loss and muscle loss.