Weight loss prior to lung transplantation is associated with improved survival
Open accessAbstract
Background Obesity is associated with increased mortality following lung transplantation and is a relative contraindication to transplant. Whether weight reduction prior to transplantation ameliorates this risk is unknown. Our objective was to determine whether weight loss prior to lung transplantation improves survival. Methods This is a two-center, retrospective cohort study of lung transplant recipients between 1/1/2000 and 11/5/2010. 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 signed-rank test and Cox Proportional Hazard model were used for analysis where appropriate. Results 355 patients (55% male; median age 59 years) satisfied inclusion and exclusion criteria. After adjusting for standard demographic and clinical measures, a one 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 a baseline BMI ≥ 25 kg/m2 (overweight and obese), 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. One unit reduction in BMI was also associated with a 6.1% decrease in median mechanical ventilator days (p = 0.02) and a trend towards decreased intensive care unit length of stay (p = 0.06). Conclusions A reduction in the 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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The magnitude of pre-transplant weight loss is directly correlated with improvements in post-transplant survival for candidates who are not underweight.
“the magnitude of pre-transplant weight loss is directly correlated with improvements in post-transplant survival for candidates who are not underweight.(43, 44)”
From Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. (2021) · cites this paper as [43]
The paper’s Change in BMI and survival section reports a greater survival benefit with greater pre-transplant BMI reduction. However, that benefit was demonstrated for candidates with baseline BMI ≥25, not for the entire group of candidates who were not underweight; it was not significant in the group with BMI ≤24.9. Page numbers were not available in our copy. (LLM, conf=0.90)
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Research works printed but not linked: 1
- [9]9. Chandrashekaran C, Keller CA, Kremers WK, et al. Weight loss prior to lung transplantation improves survival. Am J Respir Crit Care Med 2013;187:A6001.
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- Authors
- Chandrashekaran, S., Keller, C. A., Kremers, W. K., Peters, S. G., Hathcock, M. A., & Kennedy, C. C.
- Affiliations
- Mayo Clinic in Florida (US)
- Mayo Clinic (US)
- Corresponding author
- Kennedy, Cassie C.
- Venue
- The Journal of Heart and Lung Transplantation
- Publisher
- Elsevier BV
- Published
- 2015-05
- Volume
- 34
- Issue
- 5
- Pages
- 651-657
- ISSN
- 1053-2498 (ISSN-L)
- PMC
- PMC4417392
- OpenAlex
- W2014291879
- Semantic Scholar
- caf899d33b90dcf0870efbf3efac2f297ef8409f
- Cited by
- 50
- References
- 25
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 8 · 2023: 7 · 2022: 4 · 2021: 1 · 2020: 3 · 2019: 4 · 2018: 6 · 2017: 7 · 2016: 2 · 2015: 2 · 2014: 1
- FWCI
- 3.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Heart and Lung Transplantation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Mayo Clinic (UL1 TR000135)
- National Center for Advancing Translational Sciences
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Keywords
- lung transplantation, obesity, body mass index, post-transplant survival, mechanical ventilation duration, ICU length of stay, transplant mortality
- MeSH terms
- Aged, Female, Follow-Up Studies, Graft Rejection, Graft Survival, Humans, Male, Middle Aged, Retrospective Studies, United States, Weight Loss, Body Mass Index, Survival Rate, Proportional Hazards Models, Lung Transplantation, Preoperative Period
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