High Lung Allocation Score Is Associated With Increased Morbidity and Mortality Following Transplantation

Russo, Mark J.; Iribarne, Alexander; Hong, Kimberly N.; Davies, Ryan R.; Xydas, Steve; Takayama, Hiroo; Ibrahimiye, Ali N.; Gelijns, Annetine C.; Bacchetta, Matthew; D’Ovidio, Frank; Arcasoy, Selim M.; Sonett, Joshua R.

doi:10.1378/chest.09-0319

Cited by 122 publications

(82 citation statements)

References 13 publications

(11 reference statements)

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“…Caloric restriction and the time needed to achieve this BMI threshold may result in poorer nutrition, debilitation, and loss of muscle mass, and may allow for lung disease progression. The composite effect increases waiting list mortality and may actually increase the risk of perioperative morbidity and mortality (26)(27)(28).…”

Section: Original Articlementioning

confidence: 99%

Body Composition and Mortality after Adult Lung Transplantation in the United States

Singer¹,

Peterson²,

Snyder³

et al. 2014

Am J Respir Crit Care Med

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113

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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 States Objectives: 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 , 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.

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Section: Original Articlementioning

confidence: 99%

Body Composition and Mortality after Adult Lung Transplantation in the United States

Singer¹,

Peterson²,

Snyder³

et al. 2014

Am J Respir Crit Care Med

Self Cite

113

View full text Add to dashboard Cite

show abstract

“…además de esto, en el año 2004 el tiempo medio de espera para trasplante en ee.UU era 792 días, bajando a menos de 6 meses desde el año 2006. si bien el las ha logrado en parte sus objetivos, ha determinado que en algunos centros pacientes cada vez más enfermos y graves sean trasplantados. El impacto de ésto se refleja en un estudio reciente que encontró que pacientes con las > 75 tuvieron menores tasas de sobrevida y mayor morbilidad post trasplante que pacientes con las < 50 que son trasplantados 30 . dado lo anterior, en Chile, los distintos centros a nivel nacional han acordado recientemente implementar el las como forma de priorizacion en lista de espera a partir del año 2017.…”

Section: Sistema De Asignación De óRganosunclassified

Consideraciones en la derivación y selección de candidatos a trasplante pulmonar

et al. 2017

Rev. chil. enferm. respir.

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“…Lung transplantation in patients who are deemed fit enough may produce good survival rates with a reduction of death by 75% compared to waiting IPF patients. Indeed IPF is the most common reason for lung transplantation in the USA [8].…”

Section: Reviewmentioning

confidence: 99%

The Cause of Idiopathic Pulmonary Fibrosis: A Hypothesis

Rogers¹

2017

J immuno Biol

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Idiopathic pulmonary fibrosis (IPF) is a rapidly fatal condition of unknown cause. The alveolar membrane becomes thickened with collagen and inflammatory and immune cells, which accumulate in the sub-alveolar tissues. The reduction in the ability of oxygen to diffuse across the membrane leads inevitably to progressive anoxia. There is no satisfactory treatment.It is proposed that the histological changes observed in the alveolar membrane are due to an immunological reaction to foreign antigens delivered to the alveoli in the form of an aerosol. It is further proposed that repeated exposure to the same foreign antigen leads to an intense immunological reaction. It is argued that expired antigens from the patient's partner may be the source of the antigens. Further investigations of this hypothesis are likely to involve Polymer chain reaction (PCR) of the expressed breath condensate (EBC) of the relevant partner. What is the key question?Is there evidence that repetitive exposure of the alveolar epithelium to the same antigen would be consistent with the pathogenesis? What is the bottom line?Expressed breath condensate (EBC) of the partner should be investigated as the suspected antigen for the immunological reaction of the alveolar membrane in IPF. Why read on?Idiopathic pulmonary fibrosis quickly kills; it is incurable and progressive and the cause is presently unknown. This hypothesis is consistent with the known pathology and lends itself to further analysis.

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High Lung Allocation Score Is Associated With Increased Morbidity and Mortality Following Transplantation

Cited by 122 publications

References 13 publications

Body Composition and Mortality after Adult Lung Transplantation in the United States

Body Composition and Mortality after Adult Lung Transplantation in the United States

Consideraciones en la derivación y selección de candidatos a trasplante pulmonar

The Cause of Idiopathic Pulmonary Fibrosis: A Hypothesis

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