Ding Qin, Chen Wei, Chen Chang, Zhu Yu-Ming, Yang Wei-Wei, Ding Jun-Rong
Department of Nutritional, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, China.
Shanghai Engineering Research Center of Lung Transplantation, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, China.
Ann Transl Med. 2022 Jul;10(14):793. doi: 10.21037/atm-22-3125.
Lung transplantation is an effective treatment for saving the lives of patients with end-stage lung disease (ESLD). Lung transplant-related morbidity and mortality has significantly higher than other solid organ transplants. Among the pre-transplant variables that affect the survival rate after transplantation, nutritional status are associated with poor survival rate. In order to provide basis for formulating nutritional evaluations for lung transplant recipients in the future, we retrospectively analyzed the nutritional status of lung transplantation recipients and explore its correlation with the short-term prognosis.
This retrospective cohort study included patients who were hospitalized in 2020 and underwent lung transplant surgery at Shanghai Pulmonary Hospital. Inclusion criteria: (I) aged ≥18 years; (II) have been diagnosed with ESLD; (III) have received no other effective treatments; (IV) have undergone a transplantation at Shanghai Pulmonary Hospital. We summarized the patients' general information, including their sex, age, major lung disease etc. And we also collected nutritional status, such as Nutritional Risk Screening 2002 (NRS 2002), subjective global assessment (SGA) and nutritional-related indicators, including albumin, prealbumin, retinol-binding protein etc. before surgery and 1 month after surgery. In addition, we collected postoperative drainage volume, length of stay in intensive care unit (ICU), total hospital days, and hospitalization costs to evaluate the short-term prognosis.
A total of 33 lung transplant recipients were included and successfully underwent surgery. Of the patients, 16 had preoperative NRS 2002 scores ≥3 points, of whom 7 were assessed by the SGA as having mild-moderate malnutrition and 9 as having severe malnutrition. The albumin indexes of these 16 patients, including their prealbumin, and calcium contents, were significantly lower than those of patients with NRS scores <3. Patients with preoperative NRS scores ≥3 had higher drainage volumes, longer hospitalization times, and higher total hospitalization costs than those with NRS scores <3.
Lung transplant recipients have a higher incidence of nutritional risk and malnutrition, which seriously affects their short-term prognosis. Thus, in clinical practice, lung transplant recipients should be screened for nutritional risk and provided preoperative nutritional support to maintain a good preoperative status to improve their prognosis.
肺移植是挽救终末期肺病（ESLD）患者生命的有效治疗方法。肺移植相关的发病率和死亡率显著高于其他实体器官移植。在影响移植后生存率的移植前变量中，营养状况与较差的生存率相关。为了为今后制定肺移植受者的营养评估提供依据，我们回顾性分析了肺移植受者的营养状况，并探讨其与短期预后的相关性。
这项回顾性队列研究纳入了2020年住院并在上海肺科医院接受肺移植手术的患者。纳入标准：（I）年龄≥18岁；（II）已被诊断为ESLD；（III）未接受过其他有效治疗；（IV）在上海肺科医院接受过移植手术。我们总结了患者的一般信息，包括性别、年龄、主要肺部疾病等。我们还收集了营养状况，如营养风险筛查2002（NRS 2002）、主观全面评定（SGA）以及术前和术后1个月的营养相关指标，包括白蛋白、前白蛋白、视黄醇结合蛋白等。此外，我们收集了术后引流量、重症监护病房（ICU）住院时间、总住院天数和住院费用，以评估短期预后。
共纳入33例肺移植受者并成功进行了手术。其中，16例患者术前NRS 2002评分≥3分，其中7例经SGA评估为轻度至中度营养不良，9例为重度营养不良。这16例患者的白蛋白指标，包括前白蛋白和钙含量，均显著低于NRS评分<3分的患者。术前NRS评分≥3分的患者比NRS评分<3分的患者引流量更高、住院时间更长、总住院费用更高。
肺移植受者营养风险和营养不良的发生率较高，严重影响其短期预后。因此，在临床实践中，应对肺移植受者进行营养风险筛查，并提供术前营养支持，以维持良好的术前状态，改善其预后。
