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Changes in body composition after lung transplantation in children
Ursula G Kyle1, Elizabeth T Spoede, George B Mallory
1Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX 77030, USA. ukyle@bcm.edu
Insights
Pediatric lung transplant (LTx) patients experience significant weight and lean body mass (LBM) gains within 12 months post-transplant. Evaluating LBM and fat mass is crucial for assessing nutritional status after LTx.
Area of Science:
- Pediatric Pulmonology
- Transplant Medicine
- Nutritional Science
Background:
- Nutritional status and body composition are critical in pediatric lung transplant (LTx) recipients.
- Monitoring changes post-LTx aids in tailoring nutrition support and rehabilitation.
- Body composition assessment provides a more comprehensive view than traditional metrics.
Purpose of the Study:
- To determine changes in weight, lean body mass (LBM), and body fat (BF) in pediatric patients before and after LTx.
- To investigate the association between these body composition changes and lung function post-LTx.
Main Methods:
- Retrospective study of 41 pediatric LTx patients (3 months to 20.7 years).
- Dual-energy X-ray absorptiometry (DXA) used for body composition measurements.
- Measurements taken pre-LTx and at 12 or 24 months post-LTx.
Main Results:
- Pre-LTx, 41% of patients exhibited chronic malnutrition (moderate to severe growth stunting).
- Post-LTx, significant weight and LBM gains peaked at 12 months (+9.3% weight, +15.2% LBM) and were smaller at 24 months.
- LBM percentiles showed a positive correlation with pulmonary function tests (e.g., % predicted FVC).
Conclusions:
- Maximal weight and LBM recovery occur by 12 months after pediatric LTx.
- Smaller gains in weight and LBM are observed between 12 and 24 months.
- Clinicians should assess LBM and fat mass, not just height and weight, in pediatric LTx patients.
Background:
The evaluation of nutritional status, including body composition measurements, in pediatric patients before and after lung transplant (LTx) can aid in adapting nutrition support and physical rehabilitation programs to meet individual patient needs. The purpose of this retrospective study was to determine the changes in weight, lean body mass (LBM), and body fat (BF) before and after LTx and their association with lung function in pediatric patients.
Methods:
Included were 41 LTx patients, aged 3 months to 20.7 years, who had at least 2 body composition measurements determined by dual-energy X-ray absorptiometry (GE Lunar Prodigy, Waukesha, WI) in the first 2 years after LTx were measured pre-LTX and at 12 or 24 months post-LTX, for weight, LBM, and BF.
Results:
Pre-LTx, 29% of patients had moderate and 12% had severe chronic malnutrition (growth stunting). This compares with 21% of patients being moderately LBM-depleted and 23% being BF-depleted. The weight change at 12 and 24 months was +9.3% (interquartile range, 5.6%-23%) and +4.7% (0.9%-11.6%), respectively; whereas the LBM change at 12 and 24 months was +15.2% (6.8%-17.1%) and +4.2% (-0.6% to 7.7%), respectively. LBM percentiles correlated with pulmonary function tests ( % predicted forced vital capacity [ρ = 0.36, p = 0.001] and forced expiratory volume in 1 second [ρ = 0.265, p = 0.015).
Conclusions:
Maximum weight and LBM gain occur at 12 months after LTx, with smaller gains noted at 24 months. Clinicians must look beyond height and weight and evaluate LBM and fat mass in pediatric patients after LTx.
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