Korean J Transplant.  2023 Nov;37(Suppl 1):S144. 10.4285/ATW2023.F-7282.

Nutritional intervention process for a patient with lung transplantation: a case report

• Nguyen DP
• Thi VAN
• Thi HD
• Thi HN
• Pham TT
• Thi DB
• Nguyen TH

• KMID: 2551764
• DOI: http://doi.org/10.4285/ATW2023.F-7282

Abstract

Lung transplantation is a life-saving treatment for patients with end-stage lung disease. However, lung transplant recipients are at a higher risk of malnutrition, which can negatively impact their short-term prognosis. A 49-year-old male patient with idiopathic pulmonary fibrosis and diabetes underwent a deceased donor lung transplantation at the 108 Military Central Hospital in Vietnam. Before the transplant, the patient had a height of 174 cm, a weight of 56.0 kg, a body mass index of 18.5kg/m2, albumin level of 28 g/L, and subjective global assessment (SGA)-B. Enteral refeeding was initiated on the third day posttransplantation (HD#3) with small amounts of clear liquid diet. During the first week posttransplant, the patient developed pneumonia and acute kidney injury, which increased his long-term mortality risk. Intensive nutrition management was implemented following the guidelines of Kidney Disease: Improving Global Outcomes and European Society for Clinical Nutrition and Metabolism. From HD#7 (albumin 39.3 g/L, hemoglobin 91.0 g/L, lympho 1.2, SGA-B) to HD#14 (albumin 32.4 g/L, hemoglobin 84 g/L, lympho 5.2 g/L, SGA-B), the patient was fed with an energy intake of 1,000–1,200 kcal/day and a protein intake of 1.3–1.5 g/kg/day. This dietary intake was maintained for 3 weeks. After HD#21 (albumin 25 g/L, hemoglobin 73 g/L, lympho 6.7 g/L, SGA-B), when the patients kidney function had stabilized, he started with oral feeding. From HD#28 (albumin 35 g/L, hemoglobin 78 g/L, lympho 8.9 g/L, SGA-B), the patient was comprehensively fed by oral feeding. The patient’s energy and protein intake were gradually increased, and by HD#60 (albumin 27.7 g/L, hemoglobin 87 g/L, lympho 1.2 g/L, SGA-B), his energy intake was 1,500–1,700 kcal/day. After HD#90 (albumin 27.7 g/L, hemoglobin 101 g/L, lympho 1.2 g/L, SGA-B), the patients nutrition markers were stable, but his lung function had not improved significantly due to infection and clinical status. In conclusion, lung transplant recipients should be screened for nutritional risk and provided with preoperative nutritional support to improve their prognosis.