title: Obesity and primary graft dysfunction after lung transplantation: the Lung Transplant Outcomes Group Obesity Study.
abstract: BACKGROUND
  Obesity has been linked to acute lung injury and is a risk factor for early mortality after lung transplantation.
  
  
  OBJECTIVE
  To examine the associations of obesity and plasma adipokines with the risk of primary graft dysfunction after lung transplantation.
  
  
  METHODS
  We performed a prospective cohort study of 512 adult lung transplant recipients with chronic obstructive pulmonary disease or interstitial lung disease enrolled in the Lung Transplant Outcomes Group Study. In a nested case-control study, we measured plasma leptin, adiponectin, and resistin before lung transplantation and 6 and 24 hours after lung transplantation in 40 cases of primary graft dysfunction and 80 control subjects. Generalized linear mixed models and logistic regression were used to estimate risk ratios and odds ratios.
  
  
  RESULTS
  Grade 3 primary graft dysfunction developed within 72 hours of transplantation in 29% participants. Obesity was associated with a twofold increased risk of primary graft dysfunction (adjusted risk ratio 2.1; 95% confidence interval, 1.7-2.6). The risk of primary graft dysfunction increased by 40% (confidence interval, 30–50%) for each 5 kg/m(2) increase in body mass index after accounting for center, diagnosis, cardiopulmonary bypass, and transplant procedure. Higher plasma leptin levels were associated with a greater risk of primary graft dysfunction (sex-adjusted P = 0.02). The associations of both obesity and leptin with primary graft dysfunction tended to be stronger among those who did not undergo cardiopulmonary bypass.
  
  
  CONCLUSIONS
  Obesity is an independent risk factor for primary graft dysfunction after lung transplantation.
authors.affiliation: Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA. davidlederer@columbia.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Lederer
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kawut
authors.forename: Nancy
authors.initials: N
authors.lastname: Wickersham
authors.forename: Christopher
authors.initials: C
authors.lastname: Winterbottom
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Bhorade
authors.forename: Scott M
authors.initials: SM
authors.lastname: Palmer
authors.forename: James
authors.initials: J
authors.lastname: Lee
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Diamond
authors.forename: Keith M
authors.initials: KM
authors.lastname: Wille
authors.forename: Ann
authors.initials: A
authors.lastname: Weinacker
authors.forename: Vibha N
authors.initials: VN
authors.lastname: Lama
authors.forename: Maria
authors.initials: M
authors.lastname: Crespo
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Orens
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Sonett
authors.forename: Selim M
authors.initials: SM
authors.lastname: Arcasoy
authors.forename: Lorraine B
authors.initials: LB
authors.lastname: Ware
authors.forename: Jason D
authors.initials: JD
authors.lastname: Christie
mesh_terms: D052242:Adiponectin / Q000097:blood; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D020738:Leptin / Q000097:blood; D016014:Linear Models; D016015:Logistic Models; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood* / Q000150:complications* / Q000401:mortality; D016017:Odds Ratio; D050177:Overweight / Q000097:blood / Q000150:complications; D055031:Primary Graft Dysfunction / Q000097:blood* / Q000209:etiology* / Q000401:mortality; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000601:surgery*; D052243:Resistin / Q000097:blood; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D014481:United States
chemical_list: D052242:Adiponectin; D015415:Biomarkers; D020738:Leptin; D052243:Resistin