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

Ramiro Fernandez, Niloufar Safaeinili, Chitaru Kurihara, David Duston Odell, Manu Jain, Malcom McAvoy DeCamp Jr, GR Scott Budinger, Ankit Bharat

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: The association of body mass index (BMI) with survival after lung transplantation remains controversial, owing to conflicting evidence in the literature. Previous reports have used traditional BMI categories, included patients who underwent transplantation before implementation of the lung allocation score (LAS), or were limited by single-center experiences. Here we evaluated the association of individual BMI units with short-term and long-term mortality in a large national database following implementation of the LAS. Methods: The Scientific Registry of Transplant Recipients database was used to collect data for 17,233 adult lung transplantations performed between May 2005 and June 2016. The primary outcome was all-cause mortality at 90 days and 1 year posttransplantation. Logistic regression modeling was used to independently predict mortality per BMI unit, adjusting for donor and recipient factors. Results: BMI was an independent predictor of mortality at both 90 days and 1 year. At 90 days, a BMI of 25 was associated with the lowest predicted probability of death (0.053; 95% confidence interval [CI], 0.047-0.049), with increased odds of mortality at BMI ≤20 and ≥28. At 1 year, a BMI of 26 was associated with the lowest predicted probability of death (0.12; 95% CI, 0.11-0.13), with increased odds of mortality at BMI ≤24 and ≥28. Conclusions: Each individual BMI unit has a quantifiable effect on posttransplantation survival, and the patterns of effect do not fit into the predefined BMI categories. The mortality risk associated with BMI should be considered by transplant centers when making listing decisions and by regulatory bodies for estimating expected outcomes.

Original languageEnglish (US)
Pages (from-to)1871-1879.e3
JournalJournal of Thoracic and Cardiovascular Surgery
Volume155
Issue number4
DOIs
StatePublished - Apr 1 2018

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Lung Transplantation
Body Mass Index
Lung
Survival
Mortality
Databases
Confidence Intervals
Registries
Decision Making
Transplantation
Logistic Models
Tissue Donors

Keywords

  • body mass index
  • lung transplantation
  • posttransplant survival

ASJC Scopus subject areas

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

Cite this

@article{5365df21e08c43aba4459c045fe8f1f7,
title = "Association of body mass index with lung transplantation survival in the United States following implementation of the lung allocation score",
abstract = "Background: The association of body mass index (BMI) with survival after lung transplantation remains controversial, owing to conflicting evidence in the literature. Previous reports have used traditional BMI categories, included patients who underwent transplantation before implementation of the lung allocation score (LAS), or were limited by single-center experiences. Here we evaluated the association of individual BMI units with short-term and long-term mortality in a large national database following implementation of the LAS. Methods: The Scientific Registry of Transplant Recipients database was used to collect data for 17,233 adult lung transplantations performed between May 2005 and June 2016. The primary outcome was all-cause mortality at 90 days and 1 year posttransplantation. Logistic regression modeling was used to independently predict mortality per BMI unit, adjusting for donor and recipient factors. Results: BMI was an independent predictor of mortality at both 90 days and 1 year. At 90 days, a BMI of 25 was associated with the lowest predicted probability of death (0.053; 95{\%} confidence interval [CI], 0.047-0.049), with increased odds of mortality at BMI ≤20 and ≥28. At 1 year, a BMI of 26 was associated with the lowest predicted probability of death (0.12; 95{\%} CI, 0.11-0.13), with increased odds of mortality at BMI ≤24 and ≥28. Conclusions: Each individual BMI unit has a quantifiable effect on posttransplantation survival, and the patterns of effect do not fit into the predefined BMI categories. The mortality risk associated with BMI should be considered by transplant centers when making listing decisions and by regulatory bodies for estimating expected outcomes.",
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Association of body mass index with lung transplantation survival in the United States following implementation of the lung allocation score. / Fernandez, Ramiro; Safaeinili, Niloufar; Kurihara, Chitaru; Odell, David Duston; Jain, Manu; DeCamp Jr, Malcom McAvoy; Budinger, GR Scott; Bharat, Ankit.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 155, No. 4, 01.04.2018, p. 1871-1879.e3.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of body mass index with lung transplantation survival in the United States following implementation of the lung allocation score

AU - Fernandez, Ramiro

AU - Safaeinili, Niloufar

AU - Kurihara, Chitaru

AU - Odell, David Duston

AU - Jain, Manu

AU - DeCamp Jr, Malcom McAvoy

AU - Budinger, GR Scott

AU - Bharat, Ankit

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background: The association of body mass index (BMI) with survival after lung transplantation remains controversial, owing to conflicting evidence in the literature. Previous reports have used traditional BMI categories, included patients who underwent transplantation before implementation of the lung allocation score (LAS), or were limited by single-center experiences. Here we evaluated the association of individual BMI units with short-term and long-term mortality in a large national database following implementation of the LAS. Methods: The Scientific Registry of Transplant Recipients database was used to collect data for 17,233 adult lung transplantations performed between May 2005 and June 2016. The primary outcome was all-cause mortality at 90 days and 1 year posttransplantation. Logistic regression modeling was used to independently predict mortality per BMI unit, adjusting for donor and recipient factors. Results: BMI was an independent predictor of mortality at both 90 days and 1 year. At 90 days, a BMI of 25 was associated with the lowest predicted probability of death (0.053; 95% confidence interval [CI], 0.047-0.049), with increased odds of mortality at BMI ≤20 and ≥28. At 1 year, a BMI of 26 was associated with the lowest predicted probability of death (0.12; 95% CI, 0.11-0.13), with increased odds of mortality at BMI ≤24 and ≥28. Conclusions: Each individual BMI unit has a quantifiable effect on posttransplantation survival, and the patterns of effect do not fit into the predefined BMI categories. The mortality risk associated with BMI should be considered by transplant centers when making listing decisions and by regulatory bodies for estimating expected outcomes.

AB - Background: The association of body mass index (BMI) with survival after lung transplantation remains controversial, owing to conflicting evidence in the literature. Previous reports have used traditional BMI categories, included patients who underwent transplantation before implementation of the lung allocation score (LAS), or were limited by single-center experiences. Here we evaluated the association of individual BMI units with short-term and long-term mortality in a large national database following implementation of the LAS. Methods: The Scientific Registry of Transplant Recipients database was used to collect data for 17,233 adult lung transplantations performed between May 2005 and June 2016. The primary outcome was all-cause mortality at 90 days and 1 year posttransplantation. Logistic regression modeling was used to independently predict mortality per BMI unit, adjusting for donor and recipient factors. Results: BMI was an independent predictor of mortality at both 90 days and 1 year. At 90 days, a BMI of 25 was associated with the lowest predicted probability of death (0.053; 95% confidence interval [CI], 0.047-0.049), with increased odds of mortality at BMI ≤20 and ≥28. At 1 year, a BMI of 26 was associated with the lowest predicted probability of death (0.12; 95% CI, 0.11-0.13), with increased odds of mortality at BMI ≤24 and ≥28. Conclusions: Each individual BMI unit has a quantifiable effect on posttransplantation survival, and the patterns of effect do not fit into the predefined BMI categories. The mortality risk associated with BMI should be considered by transplant centers when making listing decisions and by regulatory bodies for estimating expected outcomes.

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