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Lushaj EB, DeCamp MM, Maloney J, Leverson G, De Oliveira N, McCarthy D. Body mass Index does not impact long-term survival of patients with idiopathic pulmonary fibrosis undergoing lung transplantation. FRONTIERS IN TRANSPLANTATION 2023; 2:1146779. [PMID: 38993923 PMCID: PMC11235251 DOI: 10.3389/frtra.2023.1146779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/01/2023] [Indexed: 07/13/2024]
Abstract
Objective We investigated the impact of body mass index (BMI) on post-operative outcomes and survival of patients with interstitial pulmonary fibrosis (IPF) undergoing lung transplantation. Methods We retrospectively reviewed 222 patients with IPF that underwent lung transplant (LT) at our institution from 2005 to 2019. Recipients were divided in 4 groups: group-1 consisted of underweight patients (BMI ≤18.5 kg/m2), group-2 of normal weight patients (BMI 18.5-25 kg/m2), group-3 of over-weight patients (BMI 25-29.9 kg/m2) and group-4 of obese patients (BMI ≥30 kg/m2). Results Group-1 consisted of 13 (6%) patients, group-2 of 67 (30%) patients, group-3 of 79 (36%) patients, group-4 consisted of 63 (28%) patients. Median BMI for group-1 was 17 [interquartile range (IQR): 17, 18], for group-2 was 23 (22, 24), for group-3 was 29 (28, 29.5) and group-4 was 32 (31, 33). Patients in group-1 were significantly younger (p < 0.01). Single LT comprised the majority of operation type in group-2 to group-4 and it was significantly higher than group 1 (p < 0.01). Median follow-up time was 39 months (13-76). A total of 79 (35.5%) patients died by the end of study. Overall, five deaths occurred in group-1, 17 in group-2, 33 in group-3, and 24 in group-4. Kaplan-Meier analysis showed that mortality was not statistically significant between the groups (p = 0.24). Cox-regression analysis was used to assess other possible risk factors that could influence the effect of BMI on mortality, including transplant type (single, double), lung allocation score, and age, diabetes and creatinine levels at surgery. None of these factors were shown to affect patient mortality (p > 0.05). Overall reasons for death included graft failure (24%), infection (23%), respiratory failure (14%), and malignancy (13%). Conclusions Body mass index does not impact long-term survival of patients with IPF undergoing lung transplantation.
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Affiliation(s)
- Entela B Lushaj
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Malcolm M DeCamp
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - James Maloney
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Glen Leverson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Nilto De Oliveira
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Daniel McCarthy
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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Abdulqawi R, Saleh RA, Devol E, Aldakhil H, Saleh W, Hashim M, Albogumi E, Algwaiz G, Khalid M, Al-Mutairy EA. Lung transplantation outcomes in underweight recipients: A single center experience. Heliyon 2023; 9:e15080. [PMID: 37095975 PMCID: PMC10121808 DOI: 10.1016/j.heliyon.2023.e15080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Background Current guidelines recommend a body mass index (BMI) of 16 kg/m2 as the minimum threshold for lung transplantation, despite mixed evidence on outcomes in underweight patients. The current study aimed to describe survival outcomes of underweight patients who underwent lung transplantation at a single center. Methods This retrospective observational study included adult lung transplant recipients who underwent transplantation for the first time between March 2010 and March 2022 at King Faisal Specialist Hospital and Research Center and excluded patients with obesity. We defined an underweight status as a BMI <17 kg/m2. Results Forty-eight of the 202 lung transplant recipients were underweight at the time of surgery. The underweight patients had similar lengths of hospital (p = 0.53) and intensive care unit (p = 0.81) stays compared to other patients. Thirty-three percent of underweight patients had died within 5-year follow-up, compared to 34% of patients who were not underweight. There was no significant difference in mortality risk between underweight patients and patients with normal BMIs in our multivariable Cox regression model (adjusted HR 1.57, 95%CI: 0.77-3.20, p = 0.21). Exploratory analyses revealed that a pre-transplant BMI <13 kg/m2 was associated with a trend towards increased 5-year mortality (adjusted HR 4.00, 95%CI: 0.87-18.35, p = 0.07). Conclusions Our findings suggest that patients with BMIs of 13-17 kg/m2 may be candidates for lung transplantation. Large multi-center cohort studies are needed to confirm the lower BMI limit for safely transplanting patients.
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Jennerich AL, Downey L, Goss CH, Kapnadak SG, Pryor JB, Ramos KJ. Computed tomography body composition and clinical outcomes following lung transplantation in cystic fibrosis. BMC Pulm Med 2023; 23:105. [PMID: 36997883 PMCID: PMC10062009 DOI: 10.1186/s12890-023-02398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Low muscle mass is common in patients approaching lung transplantation and may be linked to worse post-transplant outcomes. Existing studies assessing muscle mass and post-transplant outcomes include few patients with cystic fibrosis (CF). METHODS Between May 1993 and December 2018, 152 adults with CF received lung transplants at our institution. Of these, 83 met inclusion criteria and had usable computed tomography (CT) scans. Using Cox proportional hazards regression, we evaluated the association between pre-transplant thoracic skeletal muscle index (SMI) and our primary outcome of death after lung transplantation. Secondary outcomes, including days to post-transplant extubation and post-transplant hospital and intensive care unit (ICU) length of stay, were assessed using linear regression. We also examined associations between thoracic SMI and pre-transplant pulmonary function and 6-min walk distance. RESULTS Median thoracic SMI was 26.95 cm2/m2 (IQR 23.97, 31.32) for men and 22.83 cm2/m2 (IQR 21.27, 26.92) for women. There was no association between pre-transplant thoracic SMI and death after transplant (HR 1.03; 95% CI 0.95, 1.11), days to post-transplant extubation, or post-transplant hospital or ICU length of stay. There was an association between pre-transplant thoracic SMI and pre-transplant FEV1% predicted (b = 0.39; 95% CI 0.14, 0.63), with higher SMI associated with higher FEV1% predicted. CONCLUSIONS Skeletal muscle index was low for men and women. We did not identify a significant relationship between pre-transplant thoracic SMI and post-transplant outcomes. There was an association between thoracic SMI and pre-transplant pulmonary function, confirming the potential value of sarcopenia as a marker of disease severity.
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Affiliation(s)
- Ann L Jennerich
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.
| | - Lois Downey
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Christopher H Goss
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Siddhartha G Kapnadak
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Joseph B Pryor
- Department of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Kathleen J Ramos
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
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Emsley C, King S, Nyulasi I, Snell G. A GLIMmer of insight into lung transplant nutrition: Enhanced detection of malnutrition in lung transplant patients using the GLIM criteria. Clin Nutr 2021; 40:2521-2526. [PMID: 33932798 DOI: 10.1016/j.clnu.2021.02.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS The Global Leadership Initiative on Malnutrition (GLIM) is a novel framework for diagnosing malnutrition and requires evaluation in wide-ranging clinical settings. This study aimed to assess the prevalence of malnutrition and its phenotypic characteristics among lung transplantation (LTx) candidates comparing GLIM to International Classification of Diseases, 10th Revision (ICD-10) criteria. METHODS A retrospective analysis was conducted of all adult patients assessed for LTx in a one-year period. Phenotypic criteria included body mass index (BMI), unintentional loss of weight (LOW) over a 12-month period and fat-free mass index (FFMI) using bioelectrical impedance analysis (BIA). Systemic inflammation associated with severe end-stage lung disease met GLIM's etiological criterion. Diagnosis of malnutrition, and its severity, were classified according to each of GLIM and ICD-10. RESULTS Of 130 patients, 112 (86%) had all data to classify malnutrition. Malnutrition prevalence according to GLIM was 59%, which was markedly greater than using ICD-10 criteria (26%). Half of the LTx patients were moderately malnourished using GLIM, compared to 19% using ICD-10. A similar proportion were severely malnourished using GLIM (9%) and ICD-10 (7%). Fat-free mass (FFM) depletion (47% of all patients) was a major contributor to GLIM-malnutrition. Over 60% of LTx patients with GLIM-malnutrition were not detected as malnourished using ICD-10 criteria. CONCLUSION Malnutrition diagnosis using GLIM was higher than using ICD-10 in LTx patients, primarily attributable to the incorporation of quantitative evaluation of FFM depletion. This highlights the utility of the GLIM framework and the importance of including body composition in malnutrition assessment.
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Affiliation(s)
- Christie Emsley
- Nutrition Department, The Alfred Hospital, 55 Commercial Rd Melbourne, Victoria, 3004, Australia.
| | - Susannah King
- Nutrition Department, The Alfred Hospital, 55 Commercial Rd Melbourne, Victoria, 3004, Australia; Department of Dietetics, Nutrition and Sport, LaTrobe University, Bundoora, Victoria, 3068, Australia.
| | - Ibolya Nyulasi
- Nutrition Department, The Alfred Hospital, 55 Commercial Rd Melbourne, Victoria, 3004, Australia; Department of Dietetics, Nutrition and Sport, LaTrobe University, Bundoora, Victoria, 3068, Australia; Department of Medicine, Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, Victoria 3004, Australia.
| | - Gregory Snell
- Lung Transplant Service, The Alfred Hospital, 55 Commercial Rd Melbourne, Victoria, 3004, Australia.
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Kupcewicz E, Szypulska A, Doboszyńska A. Positive Orientation as a Predictor of Health Behavior during Chronic Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183408. [PMID: 31540017 PMCID: PMC6765796 DOI: 10.3390/ijerph16183408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 12/20/2022]
Abstract
Background: Positive orientation includes optimism, self-esteem, and life satisfaction. This research was conducted to determine whether positive orientation is an important predictor of health behaviors of patients with chronic movement disorders which require a rehabilitation program. Methods: The study involved 93 patients, including 46 women (49.5%) and 47 men (50.5%). The study utilized a standardized Positive Orientation Scale and a Health Behavior Inventory to measure the intensity of health-promoting behaviors. Results: The two variables of age and positive orientation were found to be predictors of overall healthy behavior, explaining a total of 22% variance of the dependent variable. Age was a predictor of preventative behavior (β = 0.37; R2 = 0.16). Its share in the prediction of this variable was significant (16%). The highest predictive value of positive mental attitude was having a positive orientation (β = 0.42; R2 = 0.17), which explained 17% of the variance of the dependent variable. However, age explained 14% of the variability of health practice results (β = 0.39; R2 = 0.14). Conclusion: The results of the research indicate the need to implement preventive programs with a positive orientation to modify the health behavior of chronically ill male and female patients.
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Affiliation(s)
- Ewa Kupcewicz
- Department of Nursing, Faculty of Health Sciences, Collegium Medicum University of Warmia and Mazury, 10-719 Olsztyn, Poland.
| | - Anna Szypulska
- Department of Nursing, Faculty of Health Sciences, Collegium Medicum University of Warmia and Mazury, 10-719 Olsztyn, Poland.
| | - Anna Doboszyńska
- Department of Nursing, Faculty of Health Sciences, Collegium Medicum University of Warmia and Mazury, 10-719 Olsztyn, Poland.
- Pulmonology Department, Faculty of Health Sciences, Collegium Medicum University of Warmia and Mazury, 10-719 Olsztyn, Poland.
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The Impact of Waiting List BMI Changes on the Short-term Outcomes of Lung Transplantation. Transplantation 2018; 102:318-325. [PMID: 28825952 DOI: 10.1097/tp.0000000000001919] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Obesity and underweight are associated with a higher postlung transplantation (LTx) mortality. This study aims to assess the impact of the changes in body mass index (BMI) during the waiting period for LTx on early postoperative outcomes. METHODS Medical records of 502 consecutive cases of LTx performed at our institution between 1999 and 2015 were reviewed. Patients were stratified per change in BMI category between pre-LTx assessment (candidate BMI) and transplant BMI as follows: A-candidate BMI, less than 18.5 or 18.5 to 29.9 and transplant BMI, less than 18.5; B-candidate BMI, less than 18.5 and transplant BMI, 18.5 to 29.9; C-candidate BMI, 18.5 to 29.9 and transplant BMI, 18.5 to 29.9; D-candidate BMI, 30 or greater and transplant BMI, 18.5 to 29.9; and E-candidate BMI, 30 or greater or 18.5 to 29.9 and transplant BMI, 30 or greater. Our primary outcome was in-hospital mortality and secondary outcomes were length of mechanical ventilation, intensive care unit length of stay (LOS), hospital LOS and postoperative complications. RESULTS BMI variation during the waiting time was common, as 1/3 of patients experienced a change in BMI category. Length of mechanical ventilation (21 days vs 9 days; P = 0.018), intensive care unit LOS (26 days vs 15 days; P = 0.035), and rates of surgical complications (76% vs 44%; P = 0.018) were significantly worse in patients of group E versus group D. Obese candidates who failed to decrease BMI less than 30 by transplant exhibited an increased risk of postoperative mortality (odds ratio, 2.62; 95% confidence interval, 1.01-6.48) compared with patients in group C. Pre-LTx BMI evolution had no impact on postoperative morbidity and mortality in underweight patients. CONCLUSIONS Our results suggest that obese candidates with an unfavorable pretransplant BMI evolution are at greater risk of worse post-LTx outcomes.
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Fernandez R, Safaeinili N, Kurihara C, Odell DD, Jain M, DeCamp MM, Budinger GRS, Bharat A. Association of body mass index with lung transplantation survival in the United States following implementation of the lung allocation score. J Thorac Cardiovasc Surg 2017; 155:1871-1879.e3. [PMID: 29249487 DOI: 10.1016/j.jtcvs.2017.11.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/12/2017] [Accepted: 11/11/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The association of body mass index (BMI) with survival after lung transplantation remains controversial, owing to conflicting evidence in the literature. Previous reports have used traditional BMI categories, included patients who underwent transplantation before implementation of the lung allocation score (LAS), or were limited by single-center experiences. Here we evaluated the association of individual BMI units with short-term and long-term mortality in a large national database following implementation of the LAS. METHODS The Scientific Registry of Transplant Recipients database was used to collect data for 17,233 adult lung transplantations performed between May 2005 and June 2016. The primary outcome was all-cause mortality at 90 days and 1 year posttransplantation. Logistic regression modeling was used to independently predict mortality per BMI unit, adjusting for donor and recipient factors. RESULTS BMI was an independent predictor of mortality at both 90 days and 1 year. At 90 days, a BMI of 25 was associated with the lowest predicted probability of death (0.053; 95% confidence interval [CI], 0.047-0.049), with increased odds of mortality at BMI ≤20 and ≥28. At 1 year, a BMI of 26 was associated with the lowest predicted probability of death (0.12; 95% CI, 0.11-0.13), with increased odds of mortality at BMI ≤24 and ≥28. CONCLUSIONS Each individual BMI unit has a quantifiable effect on posttransplantation survival, and the patterns of effect do not fit into the predefined BMI categories. The mortality risk associated with BMI should be considered by transplant centers when making listing decisions and by regulatory bodies for estimating expected outcomes.
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Affiliation(s)
- Ramiro Fernandez
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Niloufar Safaeinili
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Chitaru Kurihara
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - David D Odell
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Manu Jain
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Malcolm M DeCamp
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - G R Scott Budinger
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Ankit Bharat
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Severe underweight decreases the survival rate in adult lung transplantation. Surg Today 2017; 47:1243-1248. [DOI: 10.1007/s00595-017-1508-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/12/2017] [Indexed: 11/25/2022]
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Weig T, Milger K, Langhans B, Janitza S, Sisic A, Kenn K, Irlbeck T, Pomschar A, Johnson T, Irlbeck M, Behr J, Czerner S, Schramm R, Winter H, Neurohr C, Frey L, Kneidinger N. Core Muscle Size Predicts Postoperative Outcome in Lung Transplant Candidates. Ann Thorac Surg 2016; 101:1318-25. [DOI: 10.1016/j.athoracsur.2015.10.041] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/06/2015] [Accepted: 10/13/2015] [Indexed: 12/22/2022]
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[Advances in respiratory health 2010: Techniques and Transplantation Section]. Arch Bronconeumol 2014; 47 Suppl 1:36-40. [PMID: 21300217 DOI: 10.1016/s0300-2896(11)70010-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Five articles and an editorial on interventional pneumology were published in Archivos de Bronconeumología. Two of these articles deal with bronchoscopy, one with lung biopsy with cryoprobes, one with thermoplasty in asthma and the last with tracheobronchomalacia. We also review several publications in international journals, with special emphasis on endobronchial ultrasound. Four original articles on idiopathic pulmonary fibrosis were published in Archivos de Bronconeumología: one special article comparing two treatments and a Cochrane systematic review on the efficacy of non-steroidal drugs in this disease. Finally, we highlight studies in lung transplantation, consisting of 14 publications from different continents and with highly diverse contents: one editorial, one letter to the editor, one procedures manual and nine international publications on donor characteristics, various types of complications, experimental results in the field of preservation, and the casuistics obtained in distinct diseases in which transplantation is an option.
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Ruttens D, Verleden S, Vandermeulen E, Vos R, van Raemdonck D, Vanaudenaerde B, Verleden G. Body Mass Index in Lung Transplant Candidates: A Contra-indication to Transplant or Not? Transplant Proc 2014; 46:1506-10. [DOI: 10.1016/j.transproceed.2014.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/01/2014] [Indexed: 11/28/2022]
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Soh S, Park JH, Kim JM, Lee MJ, Koh SO, Paik HC, Park MS, Na S. Predicting Delayed Ventilator Weaning after Lung Transplantation: The Role of Body Mass Index. Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.4.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sarah Soh
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Ha Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Min Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Shin Ok Koh
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Chae Paik
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Moo Suk Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sungwon Na
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
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