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Wang DS. Pro: Early Full Nutrition is Beneficial in the Critically Ill Population. J Cardiothorac Vasc Anesth 2024; 38:1428-1430. [PMID: 38395725 DOI: 10.1053/j.jvca.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Affiliation(s)
- David S Wang
- Department of Anesthesiology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
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2
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Atchade E, De Tymowski C, Lepitre E, Zappella N, Snauwaert A, Jean-Baptiste S, Tran-Dinh A, Lortat-Jacob B, Messika J, Mal H, Mordant P, Castier Y, Tanaka S, Montravers P. Impact of recipient and donor pretransplantation body mass index on early postosperative complications after lung transplantation. BMC Pulm Med 2024; 24:161. [PMID: 38570744 PMCID: PMC10988822 DOI: 10.1186/s12890-024-02977-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Prior studies have assessed the impact of the pretransplantation recipient body mass index (BMI) on patient outcomes after lung transplantation (LT), but they have not specifically addressed early postoperative complications. Moreover, the impact of donor BMI on these complications has not been evaluated. The first aim of this study was to assess complications during hospitalization in the ICU after LT according to donor and recipient pretransplantation BMI. METHODS All the recipients who underwent LT at Bichat Claude Bernard Hospital, Paris, between January 2016 and August 2022 were included in this observational retrospective monocentric study. Postoperative complications were analyzed according to recipient and donor BMIs. Univariate and multivariate analyses were also performed. The 90-day and one-year survival rates were studied. P < 0.05 was considered to indicate statistical significance. The Paris-North Hospitals Institutional Review Board approved the study. RESULTS A total of 304 recipients were analyzed. Being underweight was observed in 41 (13%) recipients, a normal weight in 130 (43%) recipients, and being overweight/obese in 133 (44%) recipients. ECMO support during surgery was significantly more common in the overweight/obese group (p = 0.021), as were respiratory complications (primary graft dysfunction (PGD) (p = 0.006), grade 3 PDG (p = 0.018), neuroblocking agent administration (p = 0.008), prone positioning (p = 0.007)), and KDIGO 3 acute kidney injury (p = 0.036). However, pretransplantation overweight/obese status was not an independent risk factor for 90-day mortality. An overweight or obese donor was associated with a decreased PaO2/FiO2 ratio before organ donation (p < 0.001), without affecting morbidity or mortality after LT. CONCLUSION Pretransplantation overweight/obesity in recipients is strongly associated with respiratory and renal complications during hospitalization in the ICU after LT.
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Affiliation(s)
- E Atchade
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France.
| | - C De Tymowski
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France.
- UMR 1149, INSERM, Immunorecepteur Et Immunopathologie Rénale, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France.
| | - E Lepitre
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
| | - N Zappella
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
| | - A Snauwaert
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
| | - S Jean-Baptiste
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
| | - A Tran-Dinh
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
- INSERM U1148, LVTS, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France
| | - B Lortat-Jacob
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
| | - J Messika
- Service de Pneumologie B Et Transplantation Pulmonaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France
- Université de Paris Cité, UFR Diderot, Paris, France
| | - H Mal
- Service de Pneumologie B Et Transplantation Pulmonaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France
- Université de Paris Cité, UFR Diderot, Paris, France
| | - P Mordant
- Université de Paris Cité, UFR Diderot, Paris, France
- Service de Chirurgie Thoracique Et Vasculaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France
| | - Y Castier
- Université de Paris Cité, UFR Diderot, Paris, France
- Service de Chirurgie Thoracique Et Vasculaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France
| | - S Tanaka
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
- UMR 1188, Université de La Réunion, INSERM, Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France
| | - P Montravers
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
- Université de Paris Cité, UFR Diderot, Paris, France
- UMR 1152ANR-10LABX17Physiopathologie Et Epidémiologie Des Maladies Respiratoires, INSERM, Paris, France
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3
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McDonald CM, Reid EK, Pohl JF, Yuzyuk TK, Padula LM, Vavrina K, Altman K. Cystic fibrosis and fat malabsorption: Pathophysiology of the cystic fibrosis gastrointestinal tract and the impact of highly effective CFTR modulator therapy. Nutr Clin Pract 2024; 39 Suppl 1:S57-S77. [PMID: 38429959 DOI: 10.1002/ncp.11122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/28/2023] [Accepted: 12/28/2023] [Indexed: 03/03/2024] Open
Abstract
Cystic fibrosis (CF) is a progressive, genetic, multi-organ disease affecting the respiratory, digestive, endocrine, and reproductive systems. CF can affect any aspect of the gastrointestinal (GI) tract, including the esophagus, stomach, small intestine, colon, pancreas, liver, and gall bladder. GI pathophysiology associated with CF results from CF membrane conductance regulator (CFTR) dysfunction. The majority of people with CF (pwCF) experience exocrine pancreatic insufficiency resulting in malabsorption of nutrients and malnutrition. Additionally, other factors can cause or worsen fat malabsorption, including the potential for short gut syndrome with a history of meconium ileus, hepatobiliary diseases, and disrupted intraluminal factors, such as inadequate bile salts, abnormal pH, intestinal microbiome changes, and small intestinal bacterial overgrowth. Signs and symptoms associated with fat malabsorption, such as abdominal pain, bloating, malodorous flatus, gastroesophageal reflux, nausea, anorexia, steatorrhea, constipation, and distal intestinal obstruction syndrome, are seen in pwCF despite the use of pancreatic enzyme replacement therapy. Given the association of poor nutrition status with lung function decline and increased mortality, aggressive nutrition support is essential in CF care to optimize growth in children and to achieve and maintain a healthy body mass index in adults. The introduction of highly effective CFTR modulator therapy and other advances in CF care have profoundly changed the course of CF management. However, GI symptoms in some pwCF may persist. The use of current knowledge of the pathophysiology of the CF GI tract as well as appropriate, individualized management of GI symptoms continue to be integral components of care for pwCF.
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Affiliation(s)
| | - Elizabeth K Reid
- Cystic Fibrosis Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - John F Pohl
- Pediatric Gastroenterology, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Tatiana K Yuzyuk
- Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- ARUP Institute for Clinical & Experimental Pathology, Salt Lake City, Utah, USA
| | - Laura M Padula
- Pediatric Specialty, University Health, San Antonio, Texas, USA
| | - Kay Vavrina
- Pediatric Specialty, University Health, San Antonio, Texas, USA
| | - Kimberly Altman
- Gunnar Esiason Adult Cystic Fibrosis and Lung Center, Columbia University Medical Center, New York, New York, USA
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Hahn M, Wood A, Hasse JM. Nutrition support management of organ transplant recipients in the acute posttransplant phase. Nutr Clin Pract 2024; 39:45-58. [PMID: 38081296 DOI: 10.1002/ncp.11104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 01/13/2024] Open
Abstract
Patients who undergo solid organ transplant can have an extensive and challenging postoperative course. The chronicity of the disease state prior to transplant in combination with transplant-specific complications and immunosuppressant medications can lead to distinct challenges that are not observed in other critically ill patients. Although the manifestation of posttransplant complications may be specific to the organ being transplanted, there are common transplant challenges that affect nutrition therapy in these patients. Effects of malnutrition, metabolic aberrations, and posttransplant organ dysfunction should be considered when developing a nutrition care plan for patients in the immediate posttransplant phase. This article addresses the various complications that can arise in the immediate posttransplant phase among patients undergoing solid organ transplant and the appropriate nutrition interventions or considerations for this specialized patient population.
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Affiliation(s)
- Michaelann Hahn
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Abby Wood
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Jeanette M Hasse
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
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Wang LN, He W. Nursing experience of abdominal massage intervention for gastrointestinal dysfunction after lung transplantation. Transpl Immunol 2022; 72:101590. [PMID: 35346826 DOI: 10.1016/j.trim.2022.101590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Lung transplantation is the only effective way to treat end-stage lung disease. Severe gastrointestinal complications are common after lung transplantation and are associated with increased mortality. Early identification and active intervention are necessary to avoid treatment delays. Abdominal massage belongs to the category of external treatment of traditional Chinese medicine (TCM), which is often used in the treatment of internal diseases. It has an excellent effect in treating stomachache, bloating, anorexia, and constipation. CASE PRESENTATION The patient developed gastrointestinal dysfunction 16 days after lung transplantation. Through the implementation of abdominal massage intervention, symptoms were significantly relieved, weight gain occurred, and the curative effect was good. CONCLUSION Abdominal massage can relieve gastrointestinal symptoms and promote the recovery of gastrointestinal function after lung transplantation and has good curative effects. This method is worth promoting in patients who have had lung transplantation.
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Affiliation(s)
- Li-Na Wang
- Department of Lung Transplantation Rehabilitation, Rehabilitation Hospital of Huishan District, Wuxi 214181, China
| | - Wei He
- Department of Neurological Rehabilitation, Rehabilitation Hospital of Huishan District, Wuxi 214181, China.
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Padiyar J. Critical care considerations in the post-operative period for the lung transplant patient. J Thorac Dis 2022; 13:6747-6753. [PMID: 34992850 PMCID: PMC8662514 DOI: 10.21037/jtd-21-1441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 11/07/2022]
Abstract
The post-operative management of a lung transplant recipient can be complex. Several factors including medical comorbidities, severity of illness at the time of transplant and intra-operative events can affect graft function and overall survival. During the immediate post-operative period, it becomes essential for early recognition of disease-specific sequelae as they can impact the patient’s outcome and quality of life. This often necessitates a multidisciplinary team of pulmonologists, surgeons, medical sub-specialists as well as skilled nurses and respiratory therapists familiar with caring for these patients. Based on the experiences of a high-volume transplant center, this chapter will outline key considerations within each organ system in this specific patient population in the Intensive Care Unit.
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Affiliation(s)
- Josna Padiyar
- Norton Thoracic Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Arjuna A, Olson MT, Walia R. Current trends in candidate selection, contraindications, and indications for lung transplantation. J Thorac Dis 2022; 13:6514-6527. [PMID: 34992831 PMCID: PMC8662491 DOI: 10.21037/jtd-2021-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/27/2021] [Indexed: 12/23/2022]
Abstract
Lung transplantation is an established treatment option that can improve quality of life and prolong survival for select patients diagnosed with end-stage lung disease. Given the gaps in organ donation and failures to make effective use of available organs, careful selection of candidates for lung transplant remains one of the most important considerations of the transplant community. Toward this end, we briefly reviewed recent trends in pretransplant evaluation, candidate selection, organ allocation, and organ preservation techniques. Since the latest consensus statement regarding appropriate selection of lung transplant candidates, many advances in the science and practice of lung transplantation have emerged and influenced our perspective of ‘contraindications’ to transplant. These advances have made it increasingly possible to pursue lung transplant in patients with risk factors for decreased survival—namely, older recipient age, increased body mass index, previous chest surgery, poorer nutritional status, and presence of chronic infection, cardiovascular disease, or extrapulmonary comorbid conditions. Therefore, we reviewed the updated evidence demonstrating the prognostic impact of these risk factors in lung transplant recipients. Lastly, we reviewed the salient evidence for current trends in disease-specific indications for lung transplantation, such as chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis, emphysema due to alpha-1 antitrypsin deficiency, and pulmonary arterial hypertension, among other less common end-stage diseases. Overall, lung transplant remains an exciting field with considerable hope for patients as they experience remarkable improvements in quality of life and survival in the modern era.
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Affiliation(s)
- Ashwini Arjuna
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Michael T Olson
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.,University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Rajat Walia
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Di Nardo M, Tikkanen J, Husain S, Singer LG, Cypel M, Ferguson ND, Keshavjee S, Del Sorbo L. Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit. Anesthesiology 2021. [PMID: 34910811 DOI: 10.1097/ALN.0000000000004054] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The number of lung transplantations is progressively increasing worldwide, providing new challenges to interprofessional teams and the intensive care units. The outcome of lung transplantation recipients is critically affected by a complex interplay of particular pathophysiologic conditions and risk factors, knowledge of which is fundamental to appropriately manage these patients during the early postoperative course. As high-grade evidence-based guidelines are not available, the authors aimed to provide an updated review of the postoperative management of lung transplantation recipients in the intensive care unit, which addresses six main areas: (1) management of mechanical ventilation, (2) fluid and hemodynamic management, (3) immunosuppressive therapies, (4) prevention and management of neurologic complications, (5) antimicrobial therapy, and (6) management of nutritional support and abdominal complications. The integrated care provided by a dedicated multidisciplinary team is key to optimize the complex postoperative management of lung transplantation recipients in the intensive care unit.
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Abstract
OBJECTIVE Patients after renal transplantation exhibit high levels of vitamin A, which has been previously suspected to be related with immunosuppressive medication. However, this possibility has not yet been systematically studied. MATERIALS AND METHODS Altogether, 116 patients were included and divided into 2 groups based on serum creatinine levels. The mean values of vitamin A levels between the 2 groups were compared using the Student's t-test. The Pearson's correlation coefficient was calculated to assess the association between vitamin A and tacrolimus. RESULTS Elevated vitamin A levels were found in both groups, and patients with kidney dysfunction after transplantation showed higher levels of vitamin A than patients with recovered kidney function. Most important, we could not identify any significant correlations between vitamin A level and tacrolimus for both groups. After long-term and short-term monitoring for different patients, obvious individual differences emerged. Such results generally ruled out previous suspicions regarding causality between immunosuppressive medication (tacrolimus) and vitamin A elevation after renal transplantation. CONCLUSION Patients after renal transplantation showed higher serum vitamin A levels than people with a normal medical exam, even if their graft function was restored. The cause of this abnormality did not seem to be related with tacrolimus.
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Affiliation(s)
- Shulin Yang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Juan Le
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Rui Peng
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shaoting Wang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
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Miles A, Barua S, McLellan N, Brkic L. Dysphagia and medicine regimes in patients following lung transplant surgery: A retrospective review. Int J Speech Lang Pathol 2021; 23:339-348. [PMID: 32933315 DOI: 10.1080/17549507.2020.1807051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Dysphagia is reported following lung transplantation. Characteristics and trajectory for dysphagia are poorly understood. This retrospective study explored dysphagia and medicine regimes in patients following lung transplant. METHOD Medical records and endoscopic recordings of 101 patients (M:50yrs, range 20-67yrs, SD 13yrs) were reviewed. Standardised endoscopic swallowing measures were reported. Discharge reports were analysed for medicines known to cause dysphagia. RESULT All patients received bilateral sequential single-lung transplant. Prevalence of referral to speech pathology was 65% with 37 requiring more than one instrumental assessment. Twenty-nine patients were referred to otorhinolaryngology with suspected laryngeal abnormalities. Seventy-five percent of patients (n = 49/65) who received an instrumental assessment aspirated; of whom 63% aspirated silently (31/49). Diet on first day transferred from Intensive Care Unit (ICU) was significantly associated with intubation duration, ICU and hospital length of stay, tracheostomy and vocal fold paralysis (p < 0.001). In contrast, pre-operative reflux was significantly associated with diet on discharge (p < 0.05). Only three patients remained enterally fed on discharge. Polypharmacy (concurrent use of 5+ medicines) was prevalent. CONCLUSION Endoscopic, radiographic and/or manometric assessment of dysphagia in patients prior to, and following, lung transplant may allow for early management and prevention of secondary complications. Teams must consider pre-surgical reflux, length of stay in ICU and current medicine regimes when managing patients.
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Affiliation(s)
- Anna Miles
- School of Psychology, The University of Auckland, Auckland, New Zealand and
| | - Sujay Barua
- School of Psychology, The University of Auckland, Auckland, New Zealand and
| | | | - Lejla Brkic
- Auckland District Health Board, Auckland, New Zealand
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Bigelow B, Toci G, Etchill E, Krishnan A, Merlo C, Bush EL. Nutritional Risk Index: A Predictive Metric for Mortality After Lung Transplant. Ann Thorac Surg 2021; 112:214-20. [DOI: 10.1016/j.athoracsur.2020.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 07/08/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023]
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Nguyen C, Imani RA. A method for percutaneous radiologic gastrostomy tube placement without sedation as a bridge to lung transplantation. Radiol Case Rep 2021; 16:1586-1590. [PMID: 33995749 PMCID: PMC8093415 DOI: 10.1016/j.radcr.2021.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/26/2022] Open
Abstract
Gastrostomy tube placement is an appropriate option for long-term nutritional support for patients who cannot tolerate oral intake. Common indications for a gastrostomy tube include head and neck tumors and neurological disorders. Several methods for gastrostomy tube insertion exist (eg, surgical, endoscopic, and radiologic) that require sedation or general anesthesia, which can pose risks of cardiopulmonary compromise and postsurgical pulmonary complications. Unlike other methods, our practice uses a percutaneous balloon-assisted gastrostomy tube insertion method for which we can perform without sedation. We report a case of a percutaneous radiologic gastrostomy procedure for a patient with end stage lung disease as a bridge to lung transplantation, who is not a candidate for sedation and is high-risk for general anesthesia. Through enteral feeds administered through the successfully placed gastrostomy tube, the patient showed steady improvement in weight gain over the course of several months before approval for listing by the lung transplant selection committee. Our case highlights how gastrostomy tube placement can be safely performed in patients who are not sedation candidates using the minimally invasive balloon-assisted gastrostomy tube insertion method and local anesthetic.
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Affiliation(s)
- Christian Nguyen
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Reza A Imani
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
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Almutawa DA, Almuammar M, Elshafie MM, Aljuraiban GS, Alnafisah A, Abulmeaty MMA. Survival and Nutritional Status of Male and Female Heart Transplant Patients Based on the Nutritional Risk Index. Nutrients 2020; 12:nu12123868. [PMID: 33348880 PMCID: PMC7766250 DOI: 10.3390/nu12123868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 01/30/2023] Open
Abstract
Malnutrition among heart-transplant patients may affect survival. The aim was to investigate the survival and nutrition status among male and female heart transplant patients who underwent transplantation, before and 1 year after surgery based on the nutritional risk index (NRI). The medical records of ninety heart-transplant patients (2009–2014) from the King Faisal Specialist Hospital, Riyadh, were reviewed. The assessment included demographic data, anthropometric measurements, and NRI calculation. Moreover, postoperative data included the length of stay and survival. Paired t-test and survival analysis by Kaplan–Meier (KM) curves were used. A total of 90 patients (males 77.78%) were included. The prevalence of malnutrition in the preoperative phase by NRI was 60% (7.78% as severe; 40% as moderate, and 12.22% mild NRI scores). After 1 year, body mass index (BMI) and NRI increased significantly (p < 0.001). Furthermore, NRI was significantly different between men and women (p < 0.01), while KM survival curves were insignificantly different (p = 0.67). Recipients with postoperative moderate or severe nutritional risk (NRI < 97.5) had significantly shorter survival in the first-year post-transplantation (HR = 0.82; 95% CI, 0.75–0.89; p < 0.001). Our findings indicate that the NRI after 1 year of transplant correlated significantly with mortality. Besides, there was no significant gender difference regarding survival; however, malnutrition and low survival were more prominent among women.
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Affiliation(s)
- Deema A. Almutawa
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (D.A.A.); (M.A.); (M.M.E.); (G.S.A.)
- Health Sciences Department, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
| | - May Almuammar
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (D.A.A.); (M.A.); (M.M.E.); (G.S.A.)
| | - Mona Mohamed Elshafie
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (D.A.A.); (M.A.); (M.M.E.); (G.S.A.)
- Al Ghad International College of Applied Medical Sciences, Riyadh 12467, Saudi Arabia
| | - Ghadeer S. Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (D.A.A.); (M.A.); (M.M.E.); (G.S.A.)
| | - Alaa Alnafisah
- Clinical Nutrition Department, King Faisal Specialist Hospital and Research Center, Riyadh 12713, Saudi Arabia;
| | - Mahmoud M. A. Abulmeaty
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (D.A.A.); (M.A.); (M.M.E.); (G.S.A.)
- Obesity Management and Research Unit, Medical Physiology Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
- Correspondence: ; Tel.: +966-5-4815-5983
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Chohan K, Park J, Dales S, Varughese R, Wickerson L, Singer LG, Stewart B, Rozenberg D. Evaluation of Malnutrition Risk in Lung Transplant Candidates Using the Nutritional Risk Index. Transplant Direct 2020; 6:e574. [PMID: 32766429 PMCID: PMC7339342 DOI: 10.1097/txd.0000000000001028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Malnutrition in lung transplant (LTx) candidates is an important risk factor for adverse outcomes. We sought to evaluate the Nutritional Risk Index (NRI) in LTx candidates, a validated measure of malnutrition risk in chronic disease. We aimed to characterize malnutrition risk using NRI, evaluate change in body weight between nutritional risk groups, and assess association of malnutrition risk with pretransplant and posttransplant outcomes. METHODS Retrospective, single-center cohort study of LTx candidates (2014-2015) evaluated by a dietitian before listing. Nutritional parameters, weight change pretransplant and posttransplant, and clinical outcomes were abstracted up to 1-year posttransplant. NRI was calculated as follows: (1.519 × albumin) + (41.7 × current weight/ideal weight) with high malnutrition risk defined as the lowest quartile of NRI for cystic fibrosis (CF) and non-CF patients. RESULTS The cohort comprises 247 LTx candidates (57% male; median age 59 y; non-CF 88%). Non-CF candidates had a greater mean NRI compared with CF patients (109 ± 11 versus 95 ± 12; P < 0.0001). 86% with high malnutrition risk maintained/gained weight (≥5%) pretransplant. In 196 LTx recipients, malnutrition risk was not associated with hospital stay, discharge disposition, or 1-year mortality. The median percent weight gain for LTx recipients in the first year was 10.5% (4.0-20.1), with high malnutrition risk recipients having comparable or greater weight gain to the low-risk group (mean difference for non CF: 6.8%; P = 0.02 and CF: -3.8%; P = 0.65). CONCLUSIONS Malnutrition risk assessed with NRI was not prognostic of posttransplant outcomes in this retrospective cohort. LTx candidates with high malnutrition risk were able to maintain their weight pretransplant and demonstrated considerable weight gain in the first-year posttransplant.
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Affiliation(s)
- Karan Chohan
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jeff Park
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Dales
- Soham and Shaila Ajmera Family Transplant Centre, Nutrition, University Health Network, Toronto, ON, Canada
| | - Rhea Varughese
- Division of Pulmonary Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lisa Wickerson
- Toronto Lung Transplant Program, Soham and Shaila Ajmera Family Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Lianne G. Singer
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Lung Transplant Program, Soham and Shaila Ajmera Family Transplant Centre, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Respirology, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada
| | - Brooke Stewart
- Soham and Shaila Ajmera Family Transplant Centre, Nutrition, University Health Network, Toronto, ON, Canada
| | - Dmitry Rozenberg
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Lung Transplant Program, Soham and Shaila Ajmera Family Transplant Centre, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Respirology, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada
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15
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Hollander-Kraaijeveld FM, van Lanen AS, de Roos NM, van de Graaf EA, Heijerman HGM. Resting energy expenditure in cystic fibrosis patients decreases after lung transplantation, which improves applicability of prediction equations for energy requirement. J Cyst Fibros 2020; 19:975-980. [PMID: 32291160 DOI: 10.1016/j.jcf.2020.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/13/2020] [Accepted: 03/21/2020] [Indexed: 12/22/2022]
Affiliation(s)
- F M Hollander-Kraaijeveld
- Division of Internal Medicine and Dermatology, Department of Dietetics, University Medical Center Utrecht, G01.111 P.O. Box 85 500 3508 GA Utrecht Netherlands; Cystic Fibrosis and Lung Transplant Center Utrecht, University Medical Center Utrecht, Netherlands.
| | - A S van Lanen
- Division of Human Nutrition and Health, Wageningen University & Research, Netherlands
| | - N M de Roos
- Division of Human Nutrition and Health, Wageningen University & Research, Netherlands
| | - E A van de Graaf
- Division Heart and Lung, Department of Pulmonology, Cystic Fibrosis and Lung Transplant Center Utrecht, University Medical Center Utrecht, Netherlands
| | - H G M Heijerman
- Division Heart and Lung, Department of Pulmonology, Cystic Fibrosis and Lung Transplant Center Utrecht, University Medical Center Utrecht, Netherlands
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16
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Abstract
PURPOSE OF REVIEW Trace elements are vital components involved in major body functions. Cases of trace elements deficiencies are increasingly encountered in clinical practice, although often underrecognized. This review gives a thorough insight into the newest findings on clinical situations associated with trace elements deficiencies in children and adults, their recognition and management. RECENT FINDINGS Trace elements deficiencies are frequently found in various conditions, most commonly in burns, bariatric surgery, intestinal failure, renal replacement therapy, oncology, critical illness and cardiac surgery. The main trace elements involved are selenium, zinc, copper and iron. Trace elements deficiencies are associated with increased risk of morbidity and mortality. Recognition of clinical signs of trace elements deficiencies can be challenging. Although trace elements supplementation is indisputable in many circumstances, it is still debatable in other situations such as sepsis and cardiac surgery. SUMMARY Recent findings on trace elements deficiencies could have important implications on health outcomes. Trace elements delivery is a core component of nutritional care. Front-line clinicians should be aware of at-risk clinical situations to provide correct and timely intervention. Future research should be directed towards investigating the potential benefits of antioxidant trace elements supplementation in children in whom studies are scarce, especially in critical conditions such as burns, sepsis and cardiac surgery.
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17
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Affiliation(s)
- Elyn Montgomery
- Heart & Lung Transplant Program, St Vincent’s Hospital, Sydney, Australia
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Peter S. Macdonald
- Heart & Lung Transplant Program, St Vincent’s Hospital, Sydney, Australia
| | - Phillip J. Newton
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - Sunita R. Jha
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Monique Malouf
- Heart & Lung Transplant Program, St Vincent’s Hospital, Sydney, Australia
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18
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Weber Gulling M, Schaefer M, Bishop-Simo L, Keller BC. Optimizing Nutrition Assessment to Create Better Outcomes in Lung Transplant Recipients: A Review of Current Practices. Nutrients 2019; 11:E2884. [PMID: 31783495 DOI: 10.3390/nu11122884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 12/30/2022] Open
Abstract
Lung transplantation offers patients with end-stage lung disease an opportunity for a better quality of life, but with limited organ availability it is paramount that selected patients have the best opportunity for successful outcomes. Nutrition plays a central role in post-surgical outcomes and, historically, body mass index (BMI) has been used as the de facto method of assessing a lung transplant candidate’s nutritional status. Here, we review the historical origins of BMI in lung transplantation, summarize the current BMI literature, and review studies of alternative/complementary body composition assessment tools, including lean psoas area, creatinine-height index, leptin, and dual x-ray absorptiometry. These body composition measures quantify lean body mass versus fat mass and may provide a more comprehensive analysis of a patient’s nutritional state than BMI alone.
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19
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20
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Tawil JN, Adams BA, Nicoara A, Boisen ML. Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation. Semin Cardiothorac Vasc Anesth 2019; 23:171-187. [PMID: 31064319 DOI: 10.1177/1089253219845408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Publications of note from 2018 are reviewed for the cardiothoracic transplant anesthesiologist. Strategies to expand the availability of donor organs were highlighted, including improved donor management, accumulating experience with increased-risk donors, ex vivo perfusion techniques, and donation after cardiac death. A number of reports examined posttransplant outcomes, including outcomes other than mortality, with new data-driven risk models. Use of extracorporeal support in cardiothoracic transplantation was a prominent theme. Major changes in adult heart allocation criteria were implemented, aiming to improve objectivity and transparency in the listing process. Frailty and prehabilitation emerged as targets of comprehensive perioperative risk mitigation programs.
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Affiliation(s)
| | | | | | - Michael L Boisen
- 4 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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21
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Serrano-Salazar M, Medina-Zahonero L, Janeiro-Marín D, Contreras-Lorenzo C, Aguilar-Pérez M, Sánchez-Sobrino B, López-Sánchez P, Ussetti-Gil P, Portoles-Perez J. Kidney Transplantation in Patients With Chronic Kidney Disease After a Previous Lung Transplantation. Transplant Proc 2019; 51:324-327. [PMID: 30879533 DOI: 10.1016/j.transproceed.2018.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/23/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The development of chronic kidney disease is a common complication after a lung transplantation, especially since the introduction of immunosuppressive treatments based on calcineurin inhibitors. Many of these patients reach end-stage renal disease and even need renal replacement therapy. Among the different options of renal replacement therapy, we consider kidney transplantation as a feasible option for these patients. METHODS A single center, observational retrospective study including 8 lung transplanted patients who have received a kidney transplant in the period between 2013 and 2017 with at least 1 year of follow-up was used. RESULTS Seven patients maintained an adequate function of the graft 1 year after kidney transplantation, and 1 patient died because of a pulmonary condition in spite of a previous kidney transplant. Two patients presented delayed graft function in the first days after surgery. CONCLUSIONS The kidney transplantation is a technique of renal replacement therapy that should be considered in patients with previous lung transplantation. Experienced centers in double sequential lung and kidney transplantation should be established to assess and treat these types of patients.
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Affiliation(s)
| | | | - D Janeiro-Marín
- Nephrology Department, H.U. Puerta de Hierro, Majadadonda, Spain; Public Research Net REDInREN 016/009/009 ISCIII, Majadahonda, Spain
| | | | - M Aguilar-Pérez
- Pneumology Department, H.U. Puerta de Hierro, Majadahonda, Spain
| | - B Sánchez-Sobrino
- Nephrology Department, H.U. Puerta de Hierro, Majadadonda, Spain; Public Research Net REDInREN 016/009/009 ISCIII, Majadahonda, Spain
| | - P López-Sánchez
- Nephrology Department, H.U. Puerta de Hierro, Majadadonda, Spain
| | - P Ussetti-Gil
- Pneumology Department, H.U. Puerta de Hierro, Majadahonda, Spain
| | - J Portoles-Perez
- Nephrology Department, H.U. Puerta de Hierro, Majadadonda, Spain; Public Research Net REDInREN 016/009/009 ISCIII, Majadahonda, Spain.
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