Pre-transplant nutritional status: a new study
Interview with Valérie Jomphe, nutritionist
Transplant Clinic of the Notre-Dame Hospital of Montréal (CHUM)
By Tomy-Richard Leboeuf McGregor
On the occasion of the 40th European Cystic Fibrosis Conference, held in Seville in June, nutritionists Valérie Jomphe (Notre-Dame hospital transplant clinic) and Marjolaine Mailhot (Hôtel-Dieu cystic fibrosis clinic ) Presented the surprising findings of a recent study of a cohort of transplant recipients. To find out more, we met Valérie Jomphe as part of an express interview.
Hi Valérie! Since when are you a nutritionist at the CHUM transplant clinic and why are you attending this 40th European Cystic Fibrosis Conference?
This is my 15th year as a nutritionist with the CHUM Lung Transplant Program. I am present at this conference to present the results of a study evaluating the impact of pre-grafted BMI on short-term post-transplant outcomes in CF patients with CHUM pulmonary transplantation.
What were the results of the study and did they surprise you?
We retrospectively reviewed the records of the 161 pulmonary FK patients at the 1999-2015 CHUM and compared the duration of mechanical ventilation, length of stay in intensive care and length of stay in hospital. To complement the research, we also looked at mortality and post-operative complications according to BMI categories:
- Group 1: BMI <18.5
- Group 2: BMI 18.5-21.9 (female) and 18.5-22.9 (male)
- Group 3: BMI ≥ 22 (female) and ≥ 23 (male).
Intra-hospital mortality was 4.8% for group 1 and 4.4% for group 2, while no deaths were observed in group 3. These differences were not statistically significant, as were differences in complications , Duration of mechanical ventilation, and intensive care and hospital stay. We then compared the results of the transplant in patients who received invasive nutritional support (tube or intravenous) in pre-transplant to those who did not. The differences were found to be non-significant except for a tendency to have more surgical complications for the group of patients who did not receive pre-transplant invasive nutritional support. These results suggest that pre-graft BMI or having invasive nutritional support is not a significant determinant of short-term post-transplant outcomes in our FK pulmonary transplant cohort.
What has been the reception of your results and do you think this study will change the ways of doing in pulmonary transplantation?
Our results have been well received. They raised questions about the early or late indication of invasive nutritional support for CF patients candidates for transplantation. However, these results should be interpreted with caution and nuance. This study does not call into question the recommended BMI> 22 (female) and> 23 (man) targets that are associated with better lung function. However, at the terminal stage of lung disease, these targets were found to be unaffected by better post-transplant outcomes. As for the selection of a modality to support nutritional status up to transplantation, when indicated, it should be evaluated taking into account not only the BMI, but the overall nutritional status of the patient and its evolution. It is also necessary to take into account the risks and benefits of each proposed modality and, of course, to involve the patient in the decision-making process. Naturally, further studies are required to better define nutritional recommendations for CF patients candidates for pulmonary transplantation.
In closing, what changes in the nutrition of CF people after a transplant?
Pulmonary transplantation does not cure CF. Pancreatic enzymes and vitamins should be maintained following transplantation, although dose adjustments may be required. The caloric requirements are generally lower due to a decrease in energy demand induced by the correction of terminal respiratory insufficiency. Many side effects are associated with taking immunosuppressive medicines for which nutrition is a determining factor in the treatment or prevention of certain conditions such as diabetes, high blood pressure, dyslipidemia, osteoporosis or renal insufficiency. Depending on the basic nutritional status and overall condition of each patient, a nutritional treatment plan is sometimes required, which involves changes in eating habits. Overall, healthy eating is recommended after transplantation.
Thank you Valérie!