Abstract
<h3>Purpose</h3> Malnutrition and sarcopenia have been widely reported to negatively influence patients' outcomes in different clinical settings, but information is lacking about their impact on short and long-term outcomes after lung transplantation (LT). The aim of this study was to investigate which nutritional and sarcopenia indices independently predict prolonged post-operative invasive mechanical ventilation (IMV), intensive care unit (ICU) and hospital length of stay (LOS), re-intubation and rejection after LT. <h3>Methods</h3> Observational, retrospective study on patients undergoing LT in a single University Hospital was conducted between February 2016 and November 2020. Within 6 months before LT, the following data were collected: a) nutritional indices (Body Mass Index (BMI), serum albumin concentration, Prognostic Nutritional Index (PNI), Mini Nutritional Assessment Short-Form (MNA-SF)); b) sarcopenia indices (Creatinine Height Index (CHI), Skeletal Muscle Index (SMI) and densitometry of paravertebral muscles at chest CT-scan); c) postoperative clinical data related to the outcomes of interest. Univariable logistic regression models were used for binary outcomes and univariable gamma models for continuous outcomes. <h3>Results</h3> 108 of 114 patients were enrolled after excluding 6 patients for incomplete records. Seventy-two patients (67%) were male, median age was 52 [43-60] years. The main indications for BLT were interstitial (46%), septic (22%) and obstructive (19%) diseases. The IMV duration was non-linearly associated with pre-operative serum albumin (range 30-35 g/L: effect -1.67 [-2.45 - -0.89] hours, p<0.01). The ICU LOS was non-linearly correlated to albumin (range 30-35 g/L: effect -0.84 [-1.23 - -0.45] days, p<0.01) and PNI (range 25-40: effect -1.79 [-3.09 - -0.50] days, p=0.01), but linearly associated to BMI (range 20.7-27.4 kg/m<sup>2</sup>: effect +0.34 [0.03 - 0.68] days, p=0.04). No nutritional or muscle parameters predicted the need for re-intubation, the presence of rejection at 30 days and hospital LOS. <h3>Conclusion</h3> Pre-operative low serum albumin independently predicts prolonged IMV after LT, while pre-transplant low albumin, low PNI and high BMI values are associated with prolonged postoperative ICU LOS. Further studies are needed to identify the most appropriate nutritional and muscular assessment tools in BLT recipients.
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