Reversibility of cachexia after bilateral lung transplantation

Cachexia is one of the terminating syndromes in pulmonary disease, and cachectic patients have an increased mortality even after lung transplantation (LTx). Our study assessed weight changes in cachectic patients after LTx compared to normal weight LTx recipients, and investigated differences in gender, chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), and primary pulmonary hypertension (PPH).

We prospectively examined 46 patients before and serially 3, 6, 12 and 24 months after LTx (25 female, 21 male; median age at transplantation 46.9+/-13.9 years, n=17 COPD, n=8 CF, n=9 PPH, n=12 other origin). Patients were subgrouped as cachectic (BMI21, n=25).

Body weight increase was restricted to underweight patients: at 3 months (+2.1% vs. pre-transplant weight, p=0.28), 6 (+6.2%), 12 (+8.8%), and 24 months (+11.4%, all p0.05). BMI pre LTx was correlated to weight gain after LTx (r=0.29 to 0.35; all p<0.05). Weight gain was not related to diagnosis (COPD, CF or PPH), gender or age.

Weight gain after LTx is highest in underweight recipients and a continuous process from 3 months to 2 years after LTx. The weight gain is independent from the primary lung disease, and healing of this disease by LTx can make cachexia reversible. Weight increase after LTx is not affected by gender, immunosuppressive regimen, renal function before LTx, or age.