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Lorden H, Engelken J, Sprang K, Rolfson M, Mandelbrot D, Parajuli S. Malnutrition in solid organ transplant patients: A review of the literature. Clin Transplant 2023; 37:e15138. [PMID: 37715587 DOI: 10.1111/ctr.15138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023]
Abstract
Screening for malnutrition is of vital importance for solid organ transplant candidates to optimize nutrition status before transplant, to improve clinical outcomes and to inform selection committees of nutritional contraindications and risks. There are multiple criteria and screening tools available for determining malnutrition diagnosis and risk. Registered Dietitian Nutritionists use these tools for nutrition assessments to quantify the severity of malnutrition, provide patient-centered interventions, and monitor progression. Many transplant centers in the United States utilize the American Society of Parenteral and Enteral Nutrition and the Academy of Nutrition and Dietetics' Adult Malnutrition Criteria, though there is limited research using these criteria specifically in the transplant population. Malnutrition, utilizing other diagnostic and screening tools, has been associated with important complications, including longer length of hospital stay, increased mortality, decreased quality of life, worsened end-stage organ progression, and decreased functional status. Malnutrition typically results from sarcopenia and cachexia, and can ultimately lead to frailty, causing further negative impacts on transplant outcomes. This literature review summarizes the current research on malnutrition in solid organ transplant candidates and provides recommendations for future research and current practice implications.
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Affiliation(s)
- Heather Lorden
- Division of Transplantation, Department of Clinical Nutrition, UW Health Hospital and Clinics, Madison, Wisconsin, USA
| | - Jessa Engelken
- Division of Transplantation, Department of Clinical Nutrition, UW Health Hospital and Clinics, Madison, Wisconsin, USA
| | - Katrina Sprang
- Division of Transplantation, Department of Clinical Nutrition, UW Health Hospital and Clinics, Madison, Wisconsin, USA
| | - Megan Rolfson
- Division of Transplantation, Department of Clinical Nutrition, UW Health Hospital and Clinics, Madison, Wisconsin, USA
| | - Didier Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Heidel JS, Dani A, Towe C, Schecter M, Zhang Y, Hossain MM, Zafar F, Morales DLS, Hayes D. Body mass index percentage and survival in pediatric patients listed for lung transplantation: A modern-era multi-institutional analysis. J Heart Lung Transplant 2023; 42:1242-1250. [PMID: 37088338 PMCID: PMC10524024 DOI: 10.1016/j.healun.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 03/02/2023] [Accepted: 04/09/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Prior studies suggest that being underweight by body mass index percentiles (BMI%) or thinness grade did not affect post-transplant survival in pediatric lung transplant (LTx) recipients regardless of cystic fibrosis (CF) or non-CF diagnosis. Graft and overall survival from the time of listing was instead evaluated based on listing BMI%, the current standard of practice for BMI definitions in pediatrics, to ascertain the impact of a "severely low" subcategory. METHODS The UNOS registry was queried for children listed for LTx (aged 2 to <18 years) from January 1986 to March 2020. BMI% at listing and transplant were calculated per CDC guidelines according to age in years, sex, and reported BMI%. Patients were divided by listing BMI%: severely low (<3rd), low (3-<5th), normal (5-<85th), overweight (85-<95th), and obese (≥95th). Kaplan-Meier curves were generated to assess differences in overall survival since listing based on BMI% classes. Cox proportional-hazards models were developed to assess risk factors for overall and graft survival, including listing BMI%, transplant listing era (≥2005), and listing age, by reporting hazard ratios (HR). RESULTS Listing BMI% was calculable for 1,876 patients. The proportion of patients with CF differed significantly between BMI% groups (p < 0.001). Patients listed with a non-CF diagnosis comprised 34% of those in the severely low category, and 88% of those listed with an obese BMI%. Compared to patients with a normal listing BMI%, the cohort with severely low BMI% had worse overall survival regardless of LTx (p = 0.009) and graft survival (p = 0.034). Compared to patients with a low BMI%, those with a severely low BMI% had significantly poorer graft survival as well (p = 0.040). Mean graft survival was not significantly different between groups that remained at listing BMI% vs those that improved in category despite an overall small sample size. Independent predictors of poorer survival from the time of listing include severely low vs low-normal BMI% (HR = 1.20) and listing age (HR = 1.02). CONCLUSION The proportion of children listed at severely low BMI% has steadily decreased with time, yet pediatric LTx candidates listed with a severely low BMI% had poorer graft and overall survival compared to those of normal BMI%. Severely low listing BMI% was an independent prognostic factor for higher mortality risk from the time of placement on the waitlist. BMI% may be a modifiable target for improving survival regardless of transplantation.
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Affiliation(s)
- Justin S Heidel
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Alia Dani
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christopher Towe
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati Ohio
| | - Marc Schecter
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati Ohio
| | - Yin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Md Monir Hossain
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati Ohio; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Farhan Zafar
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David L S Morales
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Don Hayes
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati Ohio.
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Chen Z, Zhong M, Xu Z, Ye Q, Xie W, Gao S, Chen L, Qiu L, Jiang J, Wu H, Li X, Wang H. Development and Validation of a Nomogram Based on Geriatric Nutritional Risk Index to Predict Surgical Site Infection Among Gynecologic Oncology Patients. Front Nutr 2022; 9:864761. [PMID: 35571957 PMCID: PMC9097080 DOI: 10.3389/fnut.2022.864761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/05/2022] [Indexed: 12/29/2022] Open
Abstract
Background The geriatric nutritional risk index (GNRI) is a commonly used method to assess nutritional risk for predicting potential surgical site infections (SSI) in cancer patients. This study aims to create and verify a simple nomogram and a dynamic web-based calculator for predicting the risk of SSI among gynecologic oncology patients. Methods A retrospective evaluation was conducted on patients who were admitted into a tertiary hospital in China with confirmed diagnosis of gynecologic cancer between 01 August 2017 and 30 November 2021. A two-piecewise linear regression model with a smoothing function was used to investigate the non-linear association between GNRI and SSI to determine the ideal cut-off point. Three models were developed on the basis of different variables to predict SSI in gynecologic oncology patients. Through a nomogram the concordance index (C-index), the Akaike information criterion (AIC), and the integrated discrimination index (IDI) were used to determine the final model. Finally, the performance of the nomogram was validated using the 1,000-bootstrap resamples method and analyzed using C-index, GiViTI calibration belts, and decision curve. Also, a user-friendly dynamic web-based calculator was developed. Results A total of 1,221 patients were included in the analysis. A non-linear association could be observed between GNRI and SSI risk with a GNRI cut-off value of 101.7. After adding GNRI to Model 2 (which comprised Morse Fall Scale score, preoperative length of stay, operation time, and estimated blood loss), the AIC value decreased, the C-index value increased and IDI increased significantly. The nomogram C-index in the development cohort and internal validation cohort demonstrates a moderate-high degree of discrimination. The GiViTI calibrated belt showed a good agreement between the observed and predicted probabilities of SSI. The decision curve validates the clinical feasibility of the nomogram with a threshold value between 0 and 49%. Conclusion The GNRI cut-off value of 101.7 allowed for appropriate stratification of patients into distinct SSI risk groups. This study found that including GNRI in the above nomogram (Model 2) would enhance its potential to predict SSI in gynecologic oncology patients.
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Affiliation(s)
- Zhihui Chen
- Department of Infection Control, Wenzhou People’s Hospital, Wenzhou, China
- Department of Epidemiology and Biostatistics, Center for Clinical Big Data and Statistic, Second Affiliated Hospital, Medicine College, Zhejiang University, Hangzhou, China
| | - Mingchen Zhong
- Scientific Research Center, Wenzhou People’s Hospital, Wenzhou, China
| | - Ziqin Xu
- Department of Infection Control, Wenzhou People’s Hospital, Wenzhou, China
| | - Qing Ye
- Xinglin Information Technology Company, Hangzhou, China
| | - Wenwen Xie
- Department of Gynecology, Wenzhou People’s Hospital, Wenzhou, China
| | - Shengchun Gao
- Department of Infection Control, Wenzhou People’s Hospital, Wenzhou, China
| | - Le Chen
- Department of Infection Control, Wenzhou People’s Hospital, Wenzhou, China
| | - Lidan Qiu
- Department of Infection Control, Wenzhou People’s Hospital, Wenzhou, China
| | - Jiaru Jiang
- Department of Infection Control, Wenzhou People’s Hospital, Wenzhou, China
| | - Hongmei Wu
- Department of Infection Control, Wenzhou People’s Hospital, Wenzhou, China
| | - Xiuyang Li
- Department of Epidemiology and Biostatistics, Center for Clinical Big Data and Statistic, Second Affiliated Hospital, Medicine College, Zhejiang University, Hangzhou, China
| | - Haihong Wang
- Department of Infection Control, Wenzhou People’s Hospital, Wenzhou, China
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Shiiya H, Sato M. Lung Transplantation for Pleuroparenchymal Fibroelastosis. J Clin Med 2021; 10:jcm10050957. [PMID: 33804467 PMCID: PMC7957581 DOI: 10.3390/jcm10050957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/20/2021] [Accepted: 02/20/2021] [Indexed: 12/26/2022] Open
Abstract
Pleuroparenchymal fibroelastosis (PPFE), a new disease entity associated with interstitial pneumonia, is characterized by fibrosis and elastosis involving the pleura and subpleural lung parenchyma, predominantly in the upper lobe. As the awareness of this disease entity has increased, many studies have revealed the prevalence and incidence, clinical and pathological characteristics, and disease course of PPFE. Patients with PPFE reportedly have several unique clinical characteristics—including an extremely low body mass index with a slender body and chest wall deformity, known as “flat chest”. As this disease progresses, shrinking of the lungs often causes life-threatening complications, such as pneumothorax, and associated air leak syndrome. Lung transplantation is considered the only effective treatment for patients with advanced PPFE; however, little is known about the influences of the characteristics of PPFE on the outcome of lung transplantation. This review focuses on the unique clinicopathologic characteristics of PPFE and associated outcomes of lung transplantation for these patients.
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Affiliation(s)
- Haruhiko Shiiya
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan;
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo 060-8638, Hokkaido, Japan
| | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan;
- Correspondence: ; Tel.: +81-3-3815-5411; Fax: +81-3-5800-9156
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