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

¹ Department of Medicine, ² New York Presbyterian Lung Transplant Program, and ³ Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York

Correspondence and requests for reprints should be addressed to David J. Lederer, M.D., M.S., Division of Pulmonary, Allergy, and Critical Care Medicine, College of Physicians and Surgeons, Columbia University, 622 W 168th Street, PH-8, Room 101, New York, NY 10032. E-mail: DL427{at}columbia.edu

Rationale: Obesity is considered a relative contraindication to lung transplantation, based on studies that have not accounted for key confounders. Little is known about the risk of death for underweight candidates after transplantation.

Objectives: To examine the associations of pretransplant obesity and underweight with the risk of death after lung transplantation.

Methods: We examined 5,978 adults with cystic fibrosis, chronic obstructive pulmonary disease, and diffuse parenchymal lung disease who underwent lung transplantation in the United States between 1995 and 2003. We used Cox models and generalized additive models to examine the association between pretransplant body mass index and the risk of death after lung transplantation with adjustment for donor and recipient factors.

Measurements and Main Results: The median follow-up time was 4.2 years. Compared with normal weight recipients, the multivariable-adjusted rates of death were 15% higher for underweight recipients (95% confidence interval, 3 to 28%), 15% higher for overweight recipients (95% confidence interval, 6 to 26%), and 22% higher for obese recipients (95% confidence interval, 8 to 39%). These relationships persisted when stratified by diagnosis. The multivariable-adjusted population attributable fraction was 12% at 1 year and 8% at 5 years.

Conclusions: Both obesity and underweight are independent risk factors for death after lung transplantation, contributing to up to 12% of deaths in the first year after transplantation. Primary care providers and pulmonologists should promote a healthy weight for patients with lung disease long before transplantation is considered.

Key Words: anthropometry • body mass index • generalized additive models • lung transplantation • obesity

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Obesity has been linked to higher mortality rates after lung transplantation in studies that have not adequately controlled for potential confounding factors. The impact of underweight after lung transplantation is largely unknown. What This Study Adds to the Field Both obesity and underweight are independent risk factors for death after lung transplantation, accounting for up to 12% of deaths in the first year after transplantation.