The impact of nutritional status and body mass index on lung function, functional capacity, and mortality in lung transplant candidates: A retrospective single-center study

Background

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Aim

Lung transplantation is an important treatment option for patients with end-stage lung diseases, and outcomes may be influenced by nutritional status. This retrospective cohort study of 210 lung transplant candidates aimed to examine the associations of the Nutritional Risk Index (NRI), body mass index (BMI), and biochemical markers with functional capacity, lung function, BODE index, mortality, intensive care unit (ICU) duration, and survival.

Methods

This retrospective cohort study included 210 lung transplant candidates who were treated at a tertiary-level specialized training and research hospital between 2016–2023. The study collected biochemical measurements, Pulmonary Function Test (PFT), Six-Minute Walk Test (6MWT), bone scans, and nutritional status data. It also assessed post-transplant ICU duration and albumin levels.

Results

Severe malnutrition was prevalent (approximately 46%) across all patient groups, including those listed for transplantation, those who underwent transplantation, and those who died while awaiting. Severe malnutrition was significantly associated with lower values of BMI, FVC%, FEV1, and FEV1/FVC (p<0.01). NRI was strongly correlated with these parameters and post-transplant survival (r=0.85, p<0.001). Unlike BMI and albumin when considered alone, NRI remained an independent predictor of survival in multivariable linear regression analysis (p<0.01). Patients with hypoalbuminemia showed reduced 6MWT performance and lower NRI scores (p<0.05). Post-transplant ICU stay was prolonged in patients with severe malnutrition; however, waiting list mortality was not significantly associated with NRI after adjustment.

Conclusions

The NRI is a simple and effective nutritional screening tool for lung transplant candidates and predicts lung function and survival better than BMI or albumin alone. Routine pre-transplant nutritional optimization guided by NRI may improve post-transplant outcomes.