實習生 : 中山醫 李佳靜 指導老師 : 陳燕慈 營養師 the relationship of bmi and lung...

實習生 : 中山醫 李佳靜指導老師 : 陳燕慈 營養師

The Relationship of BMI and Lung Transplant

Recipients

1

Lung transplant

BMI risk of mortality

2

Literature(1)

Influence of Nutritional Status in Lung Transplant Recipients

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Introduction

Serum albuminSerum albumin

serum prealbuminserum prealbumin

Body Mass IndexBody Mass Index

predict malnutrition and mortalityamong hospitalized patients

Purpose:post transplantation survival rates

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MethodsBMI

Serum albuminSerum prealbumin

BMIGroup 1 <18.5

Group 2 18.5~24.9

Group 3 25~27.5

Group 4 >27.5

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Result

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Result

Obese patients (BMI>27.5 ) risk of mortality

Low levels of prealbumin ( level <18 gr/dL)

risk of mortality

Low levels of albumin No association about mortality

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Conclusion

BMI>27.5

Low pretransplant prealbumin

levels

mortality

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Literature(2)

Obesity and Underweight Are Associated with an Increased Risk of Death after Lung Transplantation

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IntroductionObesity (BMI >30 kg/m2) is considered a

relative contraindication. Little is known about underweight(BMI

<18.5 kg/m2)

Underweight → higher risk of death after lung transplantation

1- or 5-year mortality was unknown

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Purpose

We hypothesized that underweight and obesity would be associated with an increased risk of death after transplantation after adjustment for potential confounders.

Obesityv.s

underweight

risk of death

pretransplant after lung transplantation

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Methods• Participants :

Included Exclude1.Recipient age >18 years 2.single or bilateral lung transplant procedure3.cystic fibrosis(CF), chronic obstructive pulmonary disease (COPD), diffuse parenchymal lung disease(DPLD).

1.Donor age < 12 years2.Recipient or donor height < 138 cm or > 198cm3.BMI <13 or >40 kg/m2

4.Unknown height or weight5.Use mechanical ventilation

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Methods• BMI :

BMI<18.5 Underweight18.5~24.9 Normal

weight25~29.9 Overweight>30 Obese

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MethodsThe lung allocation score (LAS) was calculated

using data obtained at the time of transplantation. The primary outcome was recipient survival,

calculated as the number of days from the date of transplantation to the date of death.

They estimated odds ratios for early death (at 1 yr) and late death (at 5 yr conditional on 1-yr survival)

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ResultMedian age=54 years

3,671 single-2,307

double-

Median LAS

=32.8

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Result

Medium survival time

=4.8 years

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Result17

Discussion-Obesity

Higher risk of death due to respiratory failure among obese recipients.

A risk of death : obese > overweight

obese recipients

obese recipients

1 year after LTs

odds of

death 40%

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Discussion-Underweight

Underweight was associated with a higher risk of death after transplantation.

The greater risk of infection in underweight transplant recipients.

early mortalit

y

late mortalit

y

older populatio

n

younger recipien

ts CF

COPD

risk of death

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Discussion-Clinical ImplicationAt the extremes of BMI may be at

particularly high risk of early or late death after transplantation.

Promote long

survival

corticosteroid withdrawal and avoidanceNutritional counseling dietary modificationbariatric surgerypulmonary rehabilitation

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Conclusion

Primary care providers and pulmonologists should promote a healthy weight for patients with lung disease long before transplantation is considered.

Obesity

Obesity

underweight

underweight

Risk of deathRisk of death

12% of deaths in the first year

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Literature(3)

The impact of recipient body mass index on survival after lung transplantation

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BackgroundFew studies have examined recipient

weight and outcomes after Lung transplant (LTx). The United Network for Organ Sharing(UNOS) database provides an opportunity to examine outcomes related to body mass index (BMI) in a large cohort of LTx patients.

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MethodsData source: The UNOS data set was retrospectively

reviewed for 11,411 adult primary LTx patients (1998 to 2008)

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Methods• BMI :

BMI<18.5 Underweight18.5~24.9 Normal

weight25~29.9 Overweight>30 Obese

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MethodsThe primary end point : all-cause mortality. Secondary outcomes : rejection episodes in

the first year and short-term mortality were also examined.

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ResultFigure 1 Number of lung transplants performed

during the study period, stratified by body mass index categories

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ResultFigure 2 Kaplan-Meier estimates of survival

for lung transplant recipients stratified by body mass index categories.

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Result29

DiscussionThe increase in mortality risk was 15% for obese

patients and 14% for underweight patients.

The absolute decrease in 5-year survival was 3.0% for overweight recipients, 6.1% for obese recipients and 2.7% for underweight recipients.

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DiscussionThe increase in mortality for overweight

and obese recipients was present as early as 30 days after LTx and persisted though all follow-up times examined.

This argues strongly that the negative effect of overweight or obese BMI manifests early after LTx.

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ConclusionUnderweight, overweight, and obese

recipients have decreased survival compared with normal weight recipients.

For overweight and obese recipients, this survival difference is demonstrable as early as 30 days after LTx.

Underweight recipients do not manifest survival differences until 1 year after LTx.

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SummaryObesity OverweightUnderweight

Suggest BMI of lung transplant : normal BMI : 18.5~24.9

survival

risk of mortality

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