title: Impact of nutritional state on lung transplant outcomes.
abstract: BACKGROUND
  When high-risk lung transplant candidates are evaluated, nutritional state is often neglected. We evaluated the prevalence of markers reflecting pre-transplant malnutrition and their association with post-operative complications and death.
  
  
  METHODS
  From January 2005 to July 2010, 453 patients underwent primary lung transplantation at our institution. Pre-operative nutrition-related variables, including body mass index and weight/height ratio, reflecting cachexia, and albumin, total protein, immunoglobulins, and absolute lymphocyte count were considered in identifying risk factors for time-related major post-operative complications (renal failure requiring dialysis, respiratory failure requiring tracheostomy), pulmonary or bloodstream infections, and death.
  
  
  RESULTS
  Forty-eight patients had BMI <18.5 kg/m(2), 41 had a weight/height ratio ≤ 0.3, 102 had albumin <3.5 g/dl, 110 had total protein <6 g/dl, and 112 had an absolute lymphocyte count <1,000/μl, indicative of a malnourished state. At 6 months, 30% had experienced pulmonary infection, with lower total serum protein concentration an important risk (p = 0.02). One-year actuarial mortality was 15%; risk factors included lower serum albumin (p = 0.004), particularly when <3 g/dl. In contrast, variables reflecting nutritional state were not statistically significantly correlated with dialysis, respiratory failure requiring tracheostomy, or bloodstream infections.
  
  
  CONCLUSIONS
  Although malnutrition is uncommon in lung transplant patients, those at extremes of low serum albumin and total protein have worse survival and increased risk of post-operative infection. Strategies to improve nutrition of these high-risk candidates awaiting lung transplantation should be developed.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Themistokles
authors.initials: T
authors.lastname: Chamogeorgakis
authors.forename: David P
authors.initials: DP
authors.lastname: Mason
authors.forename: Sudish C
authors.initials: SC
authors.lastname: Murthy
authors.forename: Lucy
authors.initials: L
authors.lastname: Thuita
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Raymond
authors.forename: Gösta B
authors.initials: GB
authors.lastname: Pettersson
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
mesh_terms: D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D009752:Nutritional Status; D011183:Postoperative Complications / Q000209:etiology*; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome