Association of Nutritional Status with Clinical Outcomes of Post-bilateral Lung Transplant Patients

INTRODUCTION: Lung transplantation provides patients with end-stage lung disease a chance to improve their quality of life. However, due to limited organ availability of donor organs, patient selection is done carefully and is essential to optimise clinical outcomes. Nutritional status is a critical determinant of post-surgical outcomes.(1) While pre-transplant nutritional optimisation is essential to enhance recovery, post-transplant feeding plays an vital role. Achieving nutritional adequacy post surgery can be challenging, therefore implementing evidence-based feeding strategies is important to meet nutritional targets. OBJECTIVES: To study the association between nutritional status of patients posted for lung transplant in pre-transplant workup phase with the clinical outcomes and length of stay in hospital post surgery. To assess the feeding strategies that were used to achieve 70% of nutritional target. MATERIALS AND METHODS: A retrospective study was conducted on 18 lung transplant cases in the past two years. The nutritional status was evaluated using various standardized nutrition assessment and screening tools such as Nutrition Risk in Critically ill Score (NUTRIC Score), Prognostic Nutritional Index (PNI Score), Nutrition Risk Screening 2002 (NRS Score) and nutritional targets were set at assessment.(2) To set nutritional targets, either present body weight or ideal body weight was used for calculation as per Broca's index. The range of calories used for calculation of nutrition targets was 28-32Kcal/kg body weight for energy and 1.0-1.3gms/kg body weight for protein. RESULTS: All statistical analysis were performed using STATA 17 (StataCorp. 2021). Data on 18 lung transplant cases in the past two years were included. The mean age of the patients was 55 years and it ranged between 40 to 66 years. The median NRS 2002 score was 4, the median NUTRIC score was 5, and the median PNI was 38. Also, the median albumin level in the patient was 3.8g/dL. Post surgery, patients were started on nutritional support (Oral and Enteral) and Supplemental Parenteral Nutrition (SPN) was provided to all the patients to achieve the nutritional targets which were not met via oral/enteral nutritional support. The benchmark of more than 70 percent of the target nutrition by the 10(th) day was achieved in 16 (89 percent) of the patients. There was a strong negative correlation between the PNI score and the length of stay in hospital and ICU. Also, a strong negative correlation between the albumin level and the length of stay in hospital and ICU. Of 18 patients included in the study, death was reported in 1 of them. However, survival was seen not to be associated with any of the sociodemographic and other covariates. DISCUSSIONS/CONCLUSIONS: The current study attempted to analyze the relationship between the nutritional status of the patients and its association with clinical outcome in the patients undergoing lung transplant. PNI score and the albumin level were seen to be negatively correlated with the length of stay in hospital and ICU. Mortality status was seen not to be associated with nutritional status.(3) However, a study on larger sample will be able to provide more conclusive evidence on the impact of nutritional status on the outcome.