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134. The nutritional status of post transplant adults with cystic fibrosis
Supplement / The Netherlands Journal of Medicine 54 (1999) S3 –S84
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ness of nutritional management of CF lung-transplantation patients. It is well-documented that better nutritional status may improve survival in CF and now with the developing of lung transplantation programs it is even more important to achievement and maintenance an optimal nutritional status. Study design: the study group included 14 patients (9 females and 5 males), aged 25.7 (range 19–38). All patients were malnourished preoperatively (BMI 5 16%), The REE was significantly increased ( 1 17%) and caloric intake was 116% LARN. Nutritional management was initiated immediately in post operatively period and was based on: 1) frequent monitoring (every one or three months) of nutritional status (anthropometric parameters: BMI, mean triceps skinfold thickness and midarm muscle circumference), 2) assesment of energy requirements (3–5 day dietary record) and usage of pancreatic enzyme, 3) assesment of malabsorption (a 3 day stool collection with a 3 day dietary record, 4) measurements of basal metabolic rate (indirect calorimetry). Dietary management include the developing of individual nutrition care plans and dietary recommendations include high fat (35–40%), high protein (15–20%) and controlled carbohydrate (40–45%) with low sugars (10–15%). Conclusions: By one year post operatively patients had significantly improved their nutritional status (see Table). In our eperience nutritional rehabilitation is important to improve: a) nutritional status, b) immune response, c) muscolar status for a better FKT performance.
REE BMI %LARN
PRE TX
POST TX
1 17% 16% 116%
1 1% 21.5% 120%
134.* The nutritional status of post transplant adults with cystic fibrosis. F.A. Ashworth, S. Collins. M.E. Hodson. Dept. of Nutrition and Dietetics and Dept. of Cystic Fibrosis, Royal Brompton and Harefield NHS Trust, London, UK. As CF patients live longer, more patients are being considered for transplant and aggressive forms of nutritional support are recommended for many patients during transplant workup. We reviewed the nutritional status of 23 adult post transplant patients (16 male) who had had either single lung, double lung, heart-lung or lobe donor transplants between 1989 and the present. Pre transplantation the mean BMI of all patients was 18.3 kg / m 2 and at 6 and 12 months after transplant the means were 22.3 kg / m 2 and 21 kg / m 2 . Of the group, 5 patients required supplementary nutritional support (via gastrostomy) prior to transplantation and 4 continued for several months afterwards. However 3 other patients required supplemental nutritional support following transplantation (gastrostomy and nasogastric) due to post-op complications preventing them from gaining weight by oral means alone. Other post-transplant nutritional problems experienced include: recurrent DIOS (6 patients), obesity (3 patients), hypercholesterolaemia (1 patient), CF related diabetes (9 patients, 3 of which developed this post transplant) and renal impairment (3) requiring dietary manipulation. Our observations suggest that the high incidence of
gastrointestinal and nutritional problems post-transplant, still require regular attention and which will continue to remain a challenge to the CF team.
135.* The 12-minute walk test as an assessment criterion for 1 ¨ lung transplantation in CF patients. K. Ruter , D. Staab 1 , K. 1 1 1 2 Magdorf , I. Kleinau , K. Paul , R. Hetzer , U. Wahn 1 . 1 Dep. of Ped. Pneumology, Charite´ , Humboldt University of Berlin, 2 Deutsches Herzzentrum Berlin, Germany. We studied whether the performance in a standardized 12-min walk test is a sensitive and predictive parameter in CF patients with end stage lung disease by addressing the following questions. 1. Can walking distance be predicted by SaO 2 at rest and after exercise? 2. Can survival be predicted by the walking distance, the SaO 2 at rest or after 12 minutes walking? Patients and methods: Between 2 / 93 and 7 / 98 the 12-minute walk test was performed in 32 CF patients (15 w, 17 m; mean age 32 y) who were assessed for LTX. 11 patients (6 w, 5 m; mean age 32 y) died while being on the waiting list. The test was carried out in an enclosed hospital corridor. Patients walked quickly but comfortably and rested if necessary. The SaO 2 as well as the walking distance were documented. Results: Mean walking distance of all patients evaluated was 776 m, SaO 2 decreased from 89% to 80%. Mean walking distance of patients who died while being on the waiting list was 596 m with a SaO 2 desaturation from 80% to 71%. Walking distance and SaO 2 at rest (p 5 0.007) and after 12 minutes walking (p 5 0.015) were positively correlated. Time of survival correlates positively (p 5 0.02) with the walking distance. Conclusion: The 12-minute walk test is a sensitive and predictive parameter in evaluating CF-patients for LTX.
136.* Liver transplantation (LTx) in cystic fibrosis (CF). Experience of an Italian center. G. Rossi 1 , B. Gridelli 2 , M.L. Melzi 3 , L. Enfissi 3 , E. Moretti 3 , A. Giunta 3 . 1 Policlinico IRCCS of Milan, 2 Ospedali Riuniti Bergamo, 3 CF Center of Milan. An increasing number of CF pts are referred for LTx. Criteria for LTx are different from other diseases where chronic hepatic failure is the main indication. In CF other important parameters are to be considered: malnutrition, decreased pulmonary function (FEV1 , 60%), recurrence of lung infection or multiresistant bacteria in the sputum. In Milan CF Center 6 pts have been transplanted; 4 are alive (67%) in follow-up for 15–99 months. I pt died from hepatitis 1.5 yr after LTx and another died from aspergillosis 1 month after LTx. All pts were initially immunosuppressed with cyclosporine (CyA) and steroids; the last transplanted patient was switched to FK506 owing to poor intestinal absorption of CyA. No pt was in insulin therapy before LTx but all needed insulin during steroid therapy in the 1st year. In 2 pts after LTx surgical treatment of nasal polyposis was necessary and both were in CyA. In all our pts respiratory function improved after LTx with lower incidence of infectious events, probably because of better ventilation,
S58
ness of nutritional management of CF lung-transplantation patients. It is well-documented that better nutritional status may improve survival in CF and now with the developing of lung transplantation programs it is even more important to achievement and maintenance an optimal nutritional status. Study design: the study group included 14 patients (9 females and 5 males), aged 25.7 (range 19–38). All patients were malnourished preoperatively (BMI 5 16%), The REE was significantly increased ( 1 17%) and caloric intake was 116% LARN. Nutritional management was initiated immediately in post operatively period and was based on: 1) frequent monitoring (every one or three months) of nutritional status (anthropometric parameters: BMI, mean triceps skinfold thickness and midarm muscle circumference), 2) assesment of energy requirements (3–5 day dietary record) and usage of pancreatic enzyme, 3) assesment of malabsorption (a 3 day stool collection with a 3 day dietary record, 4) measurements of basal metabolic rate (indirect calorimetry). Dietary management include the developing of individual nutrition care plans and dietary recommendations include high fat (35–40%), high protein (15–20%) and controlled carbohydrate (40–45%) with low sugars (10–15%). Conclusions: By one year post operatively patients had significantly improved their nutritional status (see Table). In our eperience nutritional rehabilitation is important to improve: a) nutritional status, b) immune response, c) muscolar status for a better FKT performance.
REE BMI %LARN
PRE TX
POST TX
1 17% 16% 116%
1 1% 21.5% 120%
134.* The nutritional status of post transplant adults with cystic fibrosis. F.A. Ashworth, S. Collins. M.E. Hodson. Dept. of Nutrition and Dietetics and Dept. of Cystic Fibrosis, Royal Brompton and Harefield NHS Trust, London, UK. As CF patients live longer, more patients are being considered for transplant and aggressive forms of nutritional support are recommended for many patients during transplant workup. We reviewed the nutritional status of 23 adult post transplant patients (16 male) who had had either single lung, double lung, heart-lung or lobe donor transplants between 1989 and the present. Pre transplantation the mean BMI of all patients was 18.3 kg / m 2 and at 6 and 12 months after transplant the means were 22.3 kg / m 2 and 21 kg / m 2 . Of the group, 5 patients required supplementary nutritional support (via gastrostomy) prior to transplantation and 4 continued for several months afterwards. However 3 other patients required supplemental nutritional support following transplantation (gastrostomy and nasogastric) due to post-op complications preventing them from gaining weight by oral means alone. Other post-transplant nutritional problems experienced include: recurrent DIOS (6 patients), obesity (3 patients), hypercholesterolaemia (1 patient), CF related diabetes (9 patients, 3 of which developed this post transplant) and renal impairment (3) requiring dietary manipulation. Our observations suggest that the high incidence of
gastrointestinal and nutritional problems post-transplant, still require regular attention and which will continue to remain a challenge to the CF team.
135.* The 12-minute walk test as an assessment criterion for 1 ¨ lung transplantation in CF patients. K. Ruter , D. Staab 1 , K. 1 1 1 2 Magdorf , I. Kleinau , K. Paul , R. Hetzer , U. Wahn 1 . 1 Dep. of Ped. Pneumology, Charite´ , Humboldt University of Berlin, 2 Deutsches Herzzentrum Berlin, Germany. We studied whether the performance in a standardized 12-min walk test is a sensitive and predictive parameter in CF patients with end stage lung disease by addressing the following questions. 1. Can walking distance be predicted by SaO 2 at rest and after exercise? 2. Can survival be predicted by the walking distance, the SaO 2 at rest or after 12 minutes walking? Patients and methods: Between 2 / 93 and 7 / 98 the 12-minute walk test was performed in 32 CF patients (15 w, 17 m; mean age 32 y) who were assessed for LTX. 11 patients (6 w, 5 m; mean age 32 y) died while being on the waiting list. The test was carried out in an enclosed hospital corridor. Patients walked quickly but comfortably and rested if necessary. The SaO 2 as well as the walking distance were documented. Results: Mean walking distance of all patients evaluated was 776 m, SaO 2 decreased from 89% to 80%. Mean walking distance of patients who died while being on the waiting list was 596 m with a SaO 2 desaturation from 80% to 71%. Walking distance and SaO 2 at rest (p 5 0.007) and after 12 minutes walking (p 5 0.015) were positively correlated. Time of survival correlates positively (p 5 0.02) with the walking distance. Conclusion: The 12-minute walk test is a sensitive and predictive parameter in evaluating CF-patients for LTX.
136.* Liver transplantation (LTx) in cystic fibrosis (CF). Experience of an Italian center. G. Rossi 1 , B. Gridelli 2 , M.L. Melzi 3 , L. Enfissi 3 , E. Moretti 3 , A. Giunta 3 . 1 Policlinico IRCCS of Milan, 2 Ospedali Riuniti Bergamo, 3 CF Center of Milan. An increasing number of CF pts are referred for LTx. Criteria for LTx are different from other diseases where chronic hepatic failure is the main indication. In CF other important parameters are to be considered: malnutrition, decreased pulmonary function (FEV1 , 60%), recurrence of lung infection or multiresistant bacteria in the sputum. In Milan CF Center 6 pts have been transplanted; 4 are alive (67%) in follow-up for 15–99 months. I pt died from hepatitis 1.5 yr after LTx and another died from aspergillosis 1 month after LTx. All pts were initially immunosuppressed with cyclosporine (CyA) and steroids; the last transplanted patient was switched to FK506 owing to poor intestinal absorption of CyA. No pt was in insulin therapy before LTx but all needed insulin during steroid therapy in the 1st year. In 2 pts after LTx surgical treatment of nasal polyposis was necessary and both were in CyA. In all our pts respiratory function improved after LTx with lower incidence of infectious events, probably because of better ventilation,