Topical Area: Medical Nutrition
The prevalence of adults with obesity in the United States continues to increase . Obesity remains a relative contraindication to lung transplantation due to the potential for negative effects on post-transplant survival, including primary graft dysfunction . We report a case of implementing a modified very low calorie diet for weight loss in an inpatient setting to improve candidacy for lung transplantation.
A 47 year-old male with morbid obesity, chronic hypercapneic respiratory failure status post tracheostomy seven years prior, and progressive pulmonary fibrosis was admitted to the intensive care unit for worsening hypoxia at home. On admission his weight was 108.9 kilograms with body mass index of 37 kg/m², making him ineligible for lung transplantation listing and evaluation.
Due to persistently high oxygen requirements and nocturnal ventilator dependence, care for the patient could not safely be transitioned outside of an acute care setting. To achieve weight loss, we implemented a modified very low calorie diet to provide 800 kilocalories and 90-100 grams of protein per day. At the time of this report, the patient has achieved a 10.9 kilogram decrease in body weight over four weeks with stable clinical status and without new adverse events during the period on the calorie restricted diet.
Median survival after lung transplantation is approximately five years. In transplant recipients, a BMI >30 may be associated with increased short-term and long-term mortality and is a relative contraindication to transplantation [2,3]. Importantly, in patients with obesity, weight loss prior to lung transplantation may improve survival and decrease peri-operative morbidity . While this is difficult in patients with limited exercise capacity and urgent indications for transplantation, utilizing a very low calorie diet for weight loss can be effective in the proper setting, especially a monitored inpatient unit . This is important because it may allow for transplant eligibility and the possibility of transplantation for a patient that would otherwise have a limited survival period.
The use of a calorie restricted diet should be considered as a safe and effective method for rapid weight loss in an inpatient, monitored setting to allow for lung transplantation eligibility.
Funding Sources : None