The Relationship of BMI and Lung Transplant Recipients

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The Relationship of BMI and Lung Transplant
Recipients

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Lung transplant
BMI
risk of mortality
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Literature(1)

• Influence of Nutritional Status in Lung
  Transplant Recipients

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Introduction
Serum albumin
predict malnutrition and mortality among
hospitalized patients
serum prealbumin
Purpose post transplantation survival rates
Body Mass Index
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Methods

• BMI
• Serum albumin
• Serum prealbumin

BMI
Group 1 lt18.5
Group 2 18.524.9
Group 3 2527.5
Group 4 gt27.5
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Result

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Result

• Obese patients (BMIgt27.5 )
• ? risk of mortality
• Low levels of prealbumin ( level lt18 gr/dL)
• ? risk of mortality
• Low levels of albumin
• ? No association about mortality

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Conclusion
Low pretransplant prealbumin levels
BMIgt27.5
mortality
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Literature(2)

• Obesity and Underweight Are Associated with an
  Increased Risk of Death after Lung Transplantation

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Introduction

• Obesity (BMI gt30 kg/m2) is considered a relative
  contraindication.
• ?Little is known about underweight(BMI lt18.5
  kg/m2)
• Underweight ? higher risk of death after lung
  transplantation
• ? 1- or 5-year mortality was unknown

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Purpose
pretransplant
after lung transplantation
risk of death
Obesity v.s underweight

• We hypothesized that underweight and obesity
  would be associated with an increased risk of
  death after transplantation after adjustment for
  potential confounders.

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Methods

• Participants

Included Exclude
1.Recipient age gt18 years 2.single or bilateral lung transplant procedure 3.cystic fibrosis(CF), chronic obstructive pulmonary disease (COPD), diffuse parenchymal lung disease(DPLD). 1.Donor age lt 12 years 2.Recipient or donor height lt 138 cm or gt 198cm 3.BMI lt13 or gt40 kg/m2 4.Unknown height or weight 5.Use mechanical ventilation
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Methods

• BMI

BMI
lt18.5 Underweight
18.524.9 Normal weight
2529.9 Overweight
gt30 Obese
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Methods

• The lung allocation score (LAS) was calculated
  using data obtained at the time of
  transplantation.
• The primary outcome was recipient survival,
  calculated as the number of days from the date of
  transplantation to the date of death.
• They estimated odds ratios for early death (at 1
  yr) and late death (at 5 yr conditional on 1-yr
  survival)

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Result
Median age 54 years
Median LAS 32.8
3,671 single- 2,307 double-
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Result
Medium survival time 4.8 years
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Result
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Discussion-Obesity
odds of death
obese recipients
40
1 year after LTs

• Higher risk of death due to respiratory failure
  among obese recipients.
• A risk of death obese gt overweight

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Discussion-Underweight

• Underweight was associated with a higher risk of
  death after transplantation.
• The greater risk of infection in underweight
  transplant recipients.

early mortality
older population
COPD
risk of death
late mortality
younger recipients
CF
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Discussion-Clinical Implication

• At the extremes of BMI may be at particularly
  high risk of early or late death after
  transplantation.

corticosteroid withdrawal and avoidance Nutritiona
l counseling dietary modification bariatric
surgery pulmonary rehabilitation
Promote long survival
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Conclusion
underweight
Obesity
Risk of death
12 of deaths in the first year

• Primary care providers and pulmonologists should
  promote a healthy weight for patients with lung
  disease long before transplantation is considered.

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Literature(3)

• The impact of recipient body mass index on
  survival after lung transplantation

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Background

• Few studies have examined recipient weight and
  outcomes after Lung transplant (LTx). The United
  Network for Organ Sharing(UNOS) database provides
  an opportunity to examine outcomes related to
  body mass index (BMI) in a large cohort of LTx
  patients.

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Methods

• Data source
• The UNOS data set was retrospectively
  reviewed for 11,411
• adult primary LTx patients
• (1998 to 2008)

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Methods

• BMI

BMI
lt18.5 Underweight
18.524.9 Normal weight
2529.9 Overweight
gt30 Obese
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Methods

• The primary end point all-cause mortality.
• Secondary outcomes rejection episodes in the
  first year and short-term mortality were also
  examined.

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Result

• Figure 1 Number of lung transplants performed
  during the study period, stratified by body mass
  index categories

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Result

• Figure 2 Kaplan-Meier estimates of survival for
  lung transplant recipients stratified by body
  mass index categories.

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Result
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Discussion

• The increase in mortality risk was 15 for obese
  patients and 14 for underweight patients.
• The absolute decrease in 5-year survival was 3.0
  for overweight recipients, 6.1 for obese
  recipients and 2.7 for underweight recipients.

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Discussion

• The increase in mortality for overweight and
  obese recipients was present as early as 30 days
  after LTx and persisted though all follow-up
  times examined.
• This argues strongly that the negative effect of
  overweight or obese BMI manifests early after LTx.

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Conclusion

• Underweight, overweight, and obese recipients
  have decreased survival compared with normal
  weight recipients.
• For overweight and obese recipients, this
  survival difference is demonstrable as early as
  30 days after LTx.
• Underweight recipients do not manifest survival
  differences until 1 year after LTx.

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Summary

• Obesity
• Overweight
• Underweight
• Suggest BMI of lung transplant
• normal BMI 18.524.9

survival
risk of mortality
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Thanks for your attention