Prevalence and Clinical Correlates of Sarcopenia and Malnutrition in Lung Transplant Recipients Using EWGSOP2 and GLIM Criteria

Background: Sarcopenia and malnutrition may contribute to persistent functional vulnerability after lung transplantation, yet their prevalence using actual criteria, relationship and clinical correlates remain incompletely defined. Methods: Ninety-nine adult lung transplant recipients (Ltx) were included in the study during their routine follow-up. Sarcopenia was defined using EWGSOP2 criteria, integrating muscle strength, dual-energy X-ray absorptiometry-derived appendicular lean mass, and physical performance. Malnutrition was assessed using GLIM criteria before transplantation and at follow-up. Clinical, nutritional, biological, body-composition, and pulmonary-function variables were compared according to sarcopenia status. Results: Sarcopenia was identified in 17 recipients (17.2%), including 12 (12.1%) with severe sarcopenia. Malnutrition was frequent before transplantation and persisted at follow-up, affecting 52 of 98 recipients (53.1%) before transplantation and 23 of 99 recipients (23.2%) after transplantation. Sarcopenia was related to underlying diseases leading to transplantation (mainly COPD and ILD) and sarcopenic Ltx were older (66.1 ± 6.7 vs. 57.7 ± 12.6 years; p = 0.05), had greater smoking exposure (38.2 ± 25.6 vs. 22.2 ± 20.2 pack-years; p = 0.02) and prednisone dose (13.5 ± 8.1 vs. 8.9 ± 2.7 mg/day; p = 0.001). Despite a trend towards lower albuminemia (40.5 ± 4.7 vs. 42.1 ± 4.3 g/L; p = 0.07), malnutrition was not associated with sarcopenia status. Lung function improved substantially after transplantation, with mean FEV1 increasing from 25.7 ± 16.6% to 82.0 ± 25.4% predicted at assessment (p < 0.001); however, FEV1 at assessment did not differ considering sarcopenia status. Conclusions: In lung transplant recipients, EWGSOP2-defined sarcopenia was common and largely uncaptured by BMI, malnutrition status, routine biomarkers, adiposity indices, or spirometry recovery. Malnutrition was reduced by personalized nutritional support but persisted in many patients, supporting more systematic muscle-health and nutritional assessment to allow reduced post-transplant morbidity.