Severe underweight decreases the survival rate in adult lung transplantation

Komatsu, Teruya; Chen‐Yoshikawa, Toyofumi F.; Oshima, Atsunori; Harashima, Shin‐ichi; Aoyama, Akihiro; Inagaki, Nobuya; Date, Hiroshi

doi:10.1007/s00595-017-1508-8

Cited by 12 publications

(4 citation statements)

References 28 publications

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“…Being severely underweight is related to worse capacity to tolerate surgery, underlying malnutrition, and skeletal muscle loss. A study from Japan displayed that Patients with BMI <17.0 kg/m 2 had a worse prognosis than those with 17.0≤ BMI <18.5 kg/m 2 after transplantation (26). But our data show that patients with BMI <17.0 kg/m 2 did not have a worse prognosis.…”

Section: Discussioncontrasting

confidence: 70%

The outcome of lung transplantation for end-stage pulmonary diseases with pulmonary hypertension: a single-center experience

Wu¹,

Peng²,

Xu³

et al. 2022

J Thorac Dis

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Background: Lung transplantation is a treatment for end-stage lung disease. The optimal transplant strategy for patients with end-stage lung disease complicated by pulmonary hypertension (PH) is controversial. The aim of this study is to review this experience and analyze the outcomes of lung transplantation for PH. Methods: This retrospective study collected data on patients with PH undergoing lung transplantation between March 2016 and December 2019 at a single center in China. The perioperative features and shortand medium-term outcomes between single-lung transplantation (SLT) and double-lung transplantation (DLT) were compared. Kaplan-Meier methods were used to analyze overall survival across a variety of transplantation procedures, age, mean pulmonary artery pressure (mPAP), body mass index (BMI), and indications of transplantation.Results: A total of 63 patients with PH were finally included in the analysis. The mean age, mean BMI, and mPAP were 56.37 years, 19.56 kg/m 2 , and 35.4 mmHg respectively. The overall 1-, 2-, and 3-year survival was 70%, 63%, and 60%, respectively. Five (7.94%) patients died within 30 days after surgery and nine patients (14.3%) died from infection during the followed-up period. There were no significant differences in the short-and medium-term survival outcomes of SLT and DLT, but postoperative pulmonary function was better in DLT. Patients older than 60 years of age had worse survival (P=0.01). Conclusions:The short-and medium-term survival outcomes between SLT and DLT are similar in selected patients with PH. DLT provides better pulmonary function. Patients older than 60 years are associated with worse survival.

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Section: Discussioncontrasting

confidence: 70%

The outcome of lung transplantation for end-stage pulmonary diseases with pulmonary hypertension: a single-center experience

Wu¹,

Peng²,

Xu³

et al. 2022

J Thorac Dis

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“…7 Similarly, poor nutritional status, reflected by low BMI, is associated with higher mortality following lung transplantation. 8, 9 Intriguingly, however, these findings have been refuted by other studies reporting no effect of recipient BMI status on survival following lung transplantation. 10,11 The conflicting evidence in these studies results from the inconsistent use of the broad World Health Organization-defined BMI categories, small study size, and single-institution experience.…”

mentioning

confidence: 94%

Association of body mass index with lung transplantation survival in the United States following implementation of the lung allocation score

Fernández

Safaeinili

Kurihara

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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“…Although several previous studies have investigated the association between BMI before LT and postoperative prognosis, contradictory results have been reported. [38][39][40][41] Nevertheless, our multivariable analysis adjusted for covariates, including BMI, showed that severe low skeletal muscle mass at transplantation and its pronounced decrease during the waiting time significantly impacted short-term outcomes. Therefore, despite the differences in BMI, our findings could apply to other populations.…”

Section: Discussionmentioning

confidence: 79%

Impact of changes in skeletal muscle mass and quality during the waiting time on outcomes of lung transplantation

Hagiyama,

Sugimoto,

Tanaka

et al. 2023

Clinical Transplantation

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IntroductionThe association of changes in skeletal muscle mass and quality during the waiting time with outcomes of lung transplantation (LT) remains unclear. We aimed to examine the association of changes in skeletal muscle mass and quality during the waiting time, as well as preoperative skeletal muscle mass and quality, with outcomes of LT.MethodsThis study included individuals who underwent LT from brain‐dead donors. Skeletal muscle mass (cm2/m2) and quality (mean Hounsfield units [HU]) of the erector spinae muscle at the 12th thoracic level were evaluated using computed tomography. Preoperative skeletal muscle mass and quality, and their changes during the waiting time were calculated. We evaluated the associations among mechanical ventilation (MV) duration, intensive care unit (ICU) length of stay (LOS), hospital LOS, 6‐minute walk distance at discharge, and 5‐year survival after LT.ResultsThis study included 98 patients. The median waiting time was 594.5 days (interquartile range [IQR], 355.0–913.0). The median changes in skeletal muscle mass and quality were −4.4% (IQR, −13.3–3.1) and −2.9% (IQR, −16.0–4.1), respectively. Severe low skeletal muscle mass at LT was associated with prolonged ICU LOS (B = 8.46, 95% confidence interval [CI]: .51–16.42) and hospital LOS (B = 36.00, 95% CI: 3.23–68.78). Pronounced decrease in skeletal muscle mass during the waiting time was associated with prolonged MV duration (B = 7.85, 95% CI: .89–14.81) and ICU LOS (B = 7.97, 95% CI: .83–15.10).ConclusionMaintaining or increasing skeletal muscle mass during the waiting time would be beneficial to improve the short‐term outcomes of LT.

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Severe underweight decreases the survival rate in adult lung transplantation

Abstract: Standard BMI categorization per the WHO criteria is inadequate for determining the post-LT survival, especially in underweight patients. For the nutritional evaluation of underweight pre-LT patients, BMI <17.0 kg/m should be used instead of BMI <18.5 kg/m.

Cited by 12 publications

References 28 publications

The outcome of lung transplantation for end-stage pulmonary diseases with pulmonary hypertension: a single-center experience

The outcome of lung transplantation for end-stage pulmonary diseases with pulmonary hypertension: a single-center experience

Association of body mass index with lung transplantation survival in the United States following implementation of the lung allocation score

Impact of changes in skeletal muscle mass and quality during the waiting time on outcomes of lung transplantation

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