Weight loss prior to lung transplantation is associated with improved survival

Satish Chandrashekaran, Cesar A. Keller, Walter K Kremers, Steve G. Peters, Matthew A. Hathcock, Cassie Kennedy

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

BACKGROUND: Obesity is associated with increased mortality after lung transplantation and is a relative contraindication to transplant. It is unknown whether weight reduction prior to transplantation ameliorates this risk. Our objective was to determine whether weight loss prior to lung transplantation improves survival. METHODS: Our investigation was a two-center, retrospective cohort study of lung transplant recipients between January 1, 2000 and November 5, 2010. Change in weight, demographics, transplant details, lung allocation score, length of intensive care and mechanical ventilator days and graft and patient survival were abstracted. Wilcoxon's signed-rank test and the Cox proportional hazard model were used for analysis where appropriate. RESULTS: Three hundred fifty-five patients (55% male, median age 59 years) satisfied inclusion and exclusion criteria. After adjusting for standard demographic and clinical measures, a 1-unit reduction in BMI pre-transplant was associated with a reduced risk of death with a hazard ratio 0.89 (95% confidence interval 0.82 to 0.96; p = 0.004). This survival benefit persisted in the group with baseline BMI ≥25 kg/m<sup>2</sup> (overweight and obese) and hazard ratio 0.85 (95% CI 0.77 to 0.95; p = 0.003), but not in those with a BMI ≤24.9 kg/m<sup>2</sup>. The 1-unit reduction in BMI was also associated with a 6.1% decrease in median mechanical ventilator days (p = 0.02) and a trend toward decreased intensive care unit length of stay (p = 0.06). CONCLUSIONS: A reduction in BMI prior to lung transplantation was associated with a reduction in the risk of death and mechanical ventilator days. A greater reduction in BMI was associated with a greater survival benefit.

Original languageEnglish (US)
Pages (from-to)651-657
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume34
Issue number5
DOIs
StatePublished - 2015

Fingerprint

Lung Transplantation
Mechanical Ventilators
Weight Loss
Transplants
Survival
Demography
Lung
Graft Survival
Risk Reduction Behavior
Critical Care
Nonparametric Statistics
Proportional Hazards Models
Intensive Care Units
Length of Stay
Cohort Studies
Retrospective Studies
Obesity
Transplantation
Confidence Intervals
Weights and Measures

Keywords

  • Lung transplantation
  • Obesity
  • Patient selection
  • Survival
  • Weight loss

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Weight loss prior to lung transplantation is associated with improved survival. / Chandrashekaran, Satish; Keller, Cesar A.; Kremers, Walter K; Peters, Steve G.; Hathcock, Matthew A.; Kennedy, Cassie.

In: Journal of Heart and Lung Transplantation, Vol. 34, No. 5, 2015, p. 651-657.

Research output: Contribution to journalArticle

Chandrashekaran, Satish ; Keller, Cesar A. ; Kremers, Walter K ; Peters, Steve G. ; Hathcock, Matthew A. ; Kennedy, Cassie. / Weight loss prior to lung transplantation is associated with improved survival. In: Journal of Heart and Lung Transplantation. 2015 ; Vol. 34, No. 5. pp. 651-657.
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abstract = "BACKGROUND: Obesity is associated with increased mortality after lung transplantation and is a relative contraindication to transplant. It is unknown whether weight reduction prior to transplantation ameliorates this risk. Our objective was to determine whether weight loss prior to lung transplantation improves survival. METHODS: Our investigation was a two-center, retrospective cohort study of lung transplant recipients between January 1, 2000 and November 5, 2010. Change in weight, demographics, transplant details, lung allocation score, length of intensive care and mechanical ventilator days and graft and patient survival were abstracted. Wilcoxon's signed-rank test and the Cox proportional hazard model were used for analysis where appropriate. RESULTS: Three hundred fifty-five patients (55{\%} male, median age 59 years) satisfied inclusion and exclusion criteria. After adjusting for standard demographic and clinical measures, a 1-unit reduction in BMI pre-transplant was associated with a reduced risk of death with a hazard ratio 0.89 (95{\%} confidence interval 0.82 to 0.96; p = 0.004). This survival benefit persisted in the group with baseline BMI ≥25 kg/m2 (overweight and obese) and hazard ratio 0.85 (95{\%} CI 0.77 to 0.95; p = 0.003), but not in those with a BMI ≤24.9 kg/m2. The 1-unit reduction in BMI was also associated with a 6.1{\%} decrease in median mechanical ventilator days (p = 0.02) and a trend toward decreased intensive care unit length of stay (p = 0.06). CONCLUSIONS: A reduction in BMI prior to lung transplantation was associated with a reduction in the risk of death and mechanical ventilator days. A greater reduction in BMI was associated with a greater survival benefit.",
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AU - Hathcock, Matthew A.

AU - Kennedy, Cassie

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N2 - BACKGROUND: Obesity is associated with increased mortality after lung transplantation and is a relative contraindication to transplant. It is unknown whether weight reduction prior to transplantation ameliorates this risk. Our objective was to determine whether weight loss prior to lung transplantation improves survival. METHODS: Our investigation was a two-center, retrospective cohort study of lung transplant recipients between January 1, 2000 and November 5, 2010. Change in weight, demographics, transplant details, lung allocation score, length of intensive care and mechanical ventilator days and graft and patient survival were abstracted. Wilcoxon's signed-rank test and the Cox proportional hazard model were used for analysis where appropriate. RESULTS: Three hundred fifty-five patients (55% male, median age 59 years) satisfied inclusion and exclusion criteria. After adjusting for standard demographic and clinical measures, a 1-unit reduction in BMI pre-transplant was associated with a reduced risk of death with a hazard ratio 0.89 (95% confidence interval 0.82 to 0.96; p = 0.004). This survival benefit persisted in the group with baseline BMI ≥25 kg/m2 (overweight and obese) and hazard ratio 0.85 (95% CI 0.77 to 0.95; p = 0.003), but not in those with a BMI ≤24.9 kg/m2. The 1-unit reduction in BMI was also associated with a 6.1% decrease in median mechanical ventilator days (p = 0.02) and a trend toward decreased intensive care unit length of stay (p = 0.06). CONCLUSIONS: A reduction in BMI prior to lung transplantation was associated with a reduction in the risk of death and mechanical ventilator days. A greater reduction in BMI was associated with a greater survival benefit.

AB - BACKGROUND: Obesity is associated with increased mortality after lung transplantation and is a relative contraindication to transplant. It is unknown whether weight reduction prior to transplantation ameliorates this risk. Our objective was to determine whether weight loss prior to lung transplantation improves survival. METHODS: Our investigation was a two-center, retrospective cohort study of lung transplant recipients between January 1, 2000 and November 5, 2010. Change in weight, demographics, transplant details, lung allocation score, length of intensive care and mechanical ventilator days and graft and patient survival were abstracted. Wilcoxon's signed-rank test and the Cox proportional hazard model were used for analysis where appropriate. RESULTS: Three hundred fifty-five patients (55% male, median age 59 years) satisfied inclusion and exclusion criteria. After adjusting for standard demographic and clinical measures, a 1-unit reduction in BMI pre-transplant was associated with a reduced risk of death with a hazard ratio 0.89 (95% confidence interval 0.82 to 0.96; p = 0.004). This survival benefit persisted in the group with baseline BMI ≥25 kg/m2 (overweight and obese) and hazard ratio 0.85 (95% CI 0.77 to 0.95; p = 0.003), but not in those with a BMI ≤24.9 kg/m2. The 1-unit reduction in BMI was also associated with a 6.1% decrease in median mechanical ventilator days (p = 0.02) and a trend toward decreased intensive care unit length of stay (p = 0.06). CONCLUSIONS: A reduction in BMI prior to lung transplantation was associated with a reduction in the risk of death and mechanical ventilator days. A greater reduction in BMI was associated with a greater survival benefit.

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