Obesity and Underweight are Associated with an Increased Risk of Death after Lung Transplantation.

Am J Respir Crit Care Med. 2009 Jul 16. [Epub ahead of print]

Obesity and Underweight are Associated with an Increased Risk of Death after Lung Transplantation.

Lederer DJ, Wilt JS, D'Ovidio F, Bacchetta MD, Shah L, Ravichandran S, Lenoir J, Klein B, Sonett JR, Arcasoy SM.

Department of Medicine and, the New York Presbyterian Lung Transplant Program, College of Physicians and Surgeons, Columbia University, New York, New York, United States.

RATIONALE: Obesity is considered a relative contraindication to lung transplantation based on studies that have not accounted for key confounders. Little is known about the risk of death after transplantation of underweight candidates.

OBJECTIVE: To examine the associations of pre-transplant obesity and underweight with the risk of death after lung transplantation.

METHODS: We examined 5,978 adults with cystic fibrosis, chronic obstructive pulmonary disease, and diffuse parenchymal lung disease who underwent lung transplantation in the United States between 1995 and 2003. We used Cox models and generalized additive models to examine the association between pre-transplant body mass index and the risk of death after lung transplantation with adjustment for donor and recipient factors.

RESULTS: The median follow-up time was 4.2 years. Compared to normal weight recipients, the multivariable-adjusted rates of death were 15% higher for underweight recipients (95% confidence interval 3 to 28%), 15% higher for overweight recipients (95% confidence interval 6 to 26%), and 22% higher for obese recipients (95% confidence interval 8 to 39%). These relationships persisted when stratified by diagnosis. The multivariable-adjusted population attributable fraction was 12% at 1 year and 8% at 5 years.

CONCLUSIONS: Both obesity and underweight are independent risk factors for death after lung transplantation, contributing to up to 12% of deaths in the first year after transplantation. Primary care providers and pulmonologists should promote a healthy weight for patients with lung disease long before transplantation is considered.

PMID: 19608717 [PubMed - as supplied by publisher]