Improvement in the nutritional and pulmonary profiles of cystic fibrosis patients undergoing bilateral sequential lung and heart-lung transplantation

Cystic fibrosis (CF) is the most common lethal genetic disease of the white population and is associated with malnutrition. In patients undergoing thoracic surgery, poor nutrition is a risk factor for postoperative complications. The aim of this study is to characterize the nutritional profiles of CF patients undergoing pulmonary transplantation (heart-lung or bilateral lung) at our medical center between 1988 and 1996 and to assess the significance of their nutritional status on posttransplantation outcomes. We retrospectively reviewed the charts of the 31 CF patients who underwent lung transplantation. Body mass index (weight/height²) was calculated for the adult patients as an index of their relative body fat before transplantation. Preoperative biochemical nutritional parameters and pulmonary function tests were assessed. The data were then compared with data collected at 1 year after transplantation. Multivariate analysis was used to examine the relationship between preoperative parameters and transplantation outcomes. The outcome variables included initial length of hospital stay, the number of infections within the first 90 days, the number of acute rejection episodes within the first year; the occurrence of obliterative bronchiolitis within the first year; and the change in the forced expiratory volume in 1 second, forced expiratory flow between 25% and 75%, and the forced vital capacity, hematocrit, and cholesterol at 1 year. Significant differences were found in all parameters studied at the end of 1 year (p ≥ .002). An inverse correlation was demonstrated between the pretransplantation total protein/albumin ratio and the number of early infections (p = .029); however, albumin concentration alone showed no correlation. Preoperative diabetes mellitus did not correlate with any of the dependent variables. The multivariate analysis suggests that an increase in the globulin fraction of total protein may be associated with a decrease in early postoperative infections. The nutritional parameters and pulmonary function of the CF patients studied normalized by one year after transplantation. There was no increased risk of rejection or infection observed among the CF diabetic patients transplanted.