Lung Transplant Program, Centre Hospitalier de l'Université de Montréal, 900 Saint-Denis Street, Montreal, QC H2X 0A9, Canada.
Department of Pediatrics, Montreal Children's Hospital-McGill University Health Centre, 1001 Décarie Boulevard, Montreal, QC H4A 3J1, Canada.
Nutrients. 2018 Jun 19;10(6):790. doi: 10.3390/nu10060790.
An optimal nutritional status is associated with better post-transplant outcomes and survival. Post-lung transplant nutrition management is however particularly challenging as lung recipients represent a very heterogeneous group of patients in terms of age, underlying diseases, weight status and presence of comorbidities. Furthermore, the post-transplant period encompasses several stages characterized by physiological and pathophysiological changes that affect nutritional status of patients and necessitate tailored nutrition management. We provide an overview of the current state of knowledge regarding nutritional requirements in the post-lung transplant period from the immediate post-operative phase to long-term follow-up. In the immediate post-transplantation phase, the high doses of immunosuppressants and corticosteroids, the goal of maintaining hemodynamic stability, the presence of a catabolic state, and the wound healing process increase nutritional demands and lead to metabolic perturbations that necessitate nutritional interventions. As time from transplantation increases, complications such as obesity, osteoporosis, cancer, diabetes, and kidney disease, may develop and require adjustments to nutrition management. Until specific nutritional guidelines for lung recipients are elaborated, recommendations regarding nutrient requirements are formulated to provide guidance for clinicians caring for these patients. Finally, the management of recipients with special considerations is also briefly addressed.
理想的营养状况与更好的移植后结局和存活率相关。然而，肺移植后的营养管理极具挑战性，因为肺移植受者在年龄、基础疾病、体重状况和合并症方面存在很大的异质性。此外，移植后阶段包括几个阶段，这些阶段的生理和病理生理变化会影响患者的营养状况，并需要量身定制的营养管理。我们概述了肺移植后时期（从术后即刻到长期随访）的营养需求的现有知识状况。在移植后即刻阶段，高剂量的免疫抑制剂和皮质类固醇、维持血流动力学稳定的目标、分解代谢状态的存在以及伤口愈合过程会增加营养需求，并导致代谢紊乱，需要营养干预。随着移植时间的延长，可能会出现肥胖、骨质疏松症、癌症、糖尿病和肾脏疾病等并发症，这需要对营养管理进行调整。在为肺移植受者制定具体的营养指南之前，我们制定了有关营养需求的建议，为照顾这些患者的临床医生提供指导。最后，还简要介绍了特殊受者的管理。
