The Relationship of BMI and Lung Transplant Recipients 實習生 : 中山醫 李佳靜 指導老師 : 陳燕慈 營養師
Lung transplant BMI risk of mortality
Literature(1) Influence of Nutritional Status in Lung Transplant Recipients
Introduction Serum albumin predict malnutrition and mortality among hospitalized patients serum prealbumin Purpose: post transplantation survival rates BodyMass Index
Methods • BMI • Serum albumin • Serum prealbumin
Result • Obese patients (BMI>27.5 ) risk of mortality • Low levels of prealbumin ( level <18 gr/dL) risk of mortality • Low levels of albumin No association about mortality
Conclusion Low pretransplant prealbumin levels BMI>27.5 mortality
Literature(2) Obesity and Underweight Are Associated with anIncreased Risk of Death after Lung Transplantation
Introduction • Obesity (BMI >30 kg/m2) is considered a relative contraindication. Little is known about underweight(BMI <18.5 kg/m2) • Underweight→higher risk of death after lung transplantation 1- or 5-year mortality was unknown
Purpose • We hypothesized that underweight and obesity would be associated with an increased risk of death after transplantation after adjustment for potential confounders. pretransplant after lung transplantation risk of death Obesity v.s underweight
Methods • Participants :
Methods • BMI :
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 oddsratios for early death (at 1 yr) and late death (at 5 yr conditional on 1-yrsurvival)
Result Median age =54 years Median LAS =32.8 3,671 single- 2,307 double-
Result Medium survival time =4.8 years
Discussion-Obesity • Higher risk of death due to respiratory failure among obese recipients. • A risk of death :obese>overweight odds of death obese recipients 40% 1 year after LTs
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 ofdeath late mortality younger recipients CF
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 Nutritional counseling dietary modification bariatric surgery pulmonary rehabilitation Promote long survival
Conclusion • Primary careproviders and pulmonologists should promote a healthy weight forpatients with lung disease long before transplantation is considered. underweight Obesity Risk of death 12% of deaths in the first year
Literature(3) The impact of recipient body mass index on survival after lung transplantation
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.
Methods • Data source: The UNOS data set was retrospectively reviewed for 11,411 adult primary LTx patients (1998 to 2008)
Methods • BMI :
Methods • The primary end point : all-cause mortality. • Secondary outcomes :rejection episodes in the first year and short-term mortality were also examined.
Result • Figure 1 Number of lung transplants performed during the study period, stratified by body mass index categories
Result • Figure 2 Kaplan-Meier estimates of survival for lung transplant recipients stratified by body mass index categories.
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.
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.
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.
Summary • Obesity • Overweight • Underweight • Suggest BMI of lung transplant : normal BMI:18.5~24.9 survival risk of mortality