Body Composition and Mortality after Adult Lung Transplantation in the United States
Body Composition and Mortality after Adult Lung Transplantation in the United States
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DOI：
10.1164/rccm.201405-0973oc
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发表时间：
2014-11-01
影响因子：
24.7
通讯作者：
Lederer, David J.
中科院分区：
文献类型：
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作者：
Singer, Jonathan P.;Peterson, Eric R.;Lederer, David J.
理由：在美国实施基于肺分配评分 (LAS) 的器官分配系统之前进行的研究中，根据肥胖和体重不足与死亡率的关系，肥胖和体重不足是肺移植的禁忌症。目的：确定体重指数 (BMI) 和血浆瘦素水平与肺移植后生存的关系。方法：我们使用多变量调整回归模型来检查 9,073 名在美国接受肺移植的成年人的 BMI 和 1 年死亡率之间的关系2005 年 5 月至 2011 年 6 月期间，599 名肺移植结果小组研究参与者的血浆瘦素和死亡率。我们使用全身双X射线吸收法测量了142名成人肺移植候选者的体脂和骨骼肌质量。测量和主要结果：正常体重（BMI 18.5-24.9 kg/m(2)）、超重（BMI 25.0-29.9）和I级肥胖（BMI 30-34.9）移植受者的调整后死亡率相似。体重不足（BMI < 18.5）与死亡率增加 35% 相关（95% 置信区间，10-66%）。 II-III 级肥胖（BMI >= 35 kg/m(2)）与死亡率增加近两倍相关（风险比，1.9；95% 置信区间，1.3-2.8）。较高的瘦素水平与不进行体外循环的移植手术后死亡率增加相关（交互作用 P = 0.03）。 BMI大于或等于30 kg/m(2)对全身脂肪定义的肥胖敏感度为26%，特异性为97%。结论：BMI为30.0-34.9 kg/m(2)与LAS时代肺移植后1年死亡率无关，可能是因为其对肥胖的敏感度较低。瘦素与死亡率之间的关联表明需要验证替代方法来测量肺移植候选者的肥胖情况。 BMI 大于或等于 30 kg/m(2) 可能不再是肺移植的禁忌。
Rationale: Obesity and underweight are contraindications to lung transplantation based on their associations with mortality in studies performed before implementation of the lung allocation score (LAS)-based organ allocation system in the United StatesObjectives: To determine the associations of body mass index (BMI) and plasma leptin levels with survival after lung transplantation.Methods: We used multivariable-adjusted regression models to examine associations between BMI and 1-year mortality in 9,073 adults who underwent lung transplantation in the United States between May 2005 and June 2011, and plasma leptin and mortality in 599 Lung Transplant Outcomes Group study participants. We measured body fat and skeletal muscle mass using whole-body dual X-ray absorptiometry in 142 adult lung transplant candidates.Measurements and Main Results: Adjusted mortality rates were similar among normal weight (BMI 18.5-24.9 kg/m(2)), overweight (BMI 25.0-29.9), and class I obese (BMI 30-34.9) transplant recipients. Underweight (BMI < 18.5) was associated with a 35% increased rate of death (95% confidence interval, 10-66%). Class II-III obesity (BMI >= 35 kg/m(2)) was associated with a nearly twofold increase in mortality (hazard ratio, 1.9; 95% confidence interval, 1.3-2.8). Higher leptin levels were associated with increased mortality after transplant surgery performed without cardiopulmonary bypass (P for interaction = 0.03). A BMI greater than or equal to 30 kg/m(2) was 26% sensitive and 97% specific for total body fat-defined obesity.Conclusions: A BMI of 30.0-34.9 kg/m(2) is not associated with 1-year mortality after lung transplantation in the LAS era, perhaps because of its low sensitivity for obesity. The association between leptin and mortality suggests the need to validate alternative methods to measure obesity in candidates for lung transplantation. A BMI greater than or equal to 30 kg/m(2) may no longer contraindicate lung transplantation.