title: Impact of donor-to-recipient weight ratio on survival after bilateral lung transplantation.
abstract: BACKGROUND
  The aim of this study was to investigate the relationship between donor-to-recipient weight ratio and post-transplantation survival.
  
  
  METHODS
  From February 1988 to November 2006, 255 adult bilateral lung transplantation patients from 2 different centers were retrospectively analyzed. The cohort was divided into 4 groups depending on the quartile ranges of the donor-to-recipient weight ratio. A time-to-event analysis was performed for risk of death after transplantation conditional on 5-year survival using Kaplan-Meier and Cox proportional hazards models.
  
  
  RESULTS
  The mean weight ratio for the study cohort was 1.23 ± 0.39. For all lung transplant recipients during the study period, survival rate at 5 years was 58%. Median survival was 6.3 years in the cohort subgroup with weight ratio <1.23, whereas the median survival was 7.7 years for the cohort subgroup with weight ratio >1.23. Weight ratio >1.23 recipients had a significant survival advantage out to 5 years compared with weight ratio <1.23 recipients (66.1% vs 51.1%, P = .0126). With the aim to assess underweight and overweight donors vs recipients, we have divided all patients into 4 groups, from quartile 1 to 4, based on donor-to-recipient weight ratio. Weight ratio strata affected overall survival, with quartile 1 (lower weight ratio recipients) experiencing the lowest 5-year survival (39.1%), followed by quartile 2 (57.8%), quartile 4 (68.2%), and quartile 3 (70.3%) recipients. The effect of weight ratio strata on survival was statistically significant for the quartile 1 recipients (lower quartile) as compared with the 3 other quartiles.
  
  
  CONCLUSIONS
  Our findings show a statistically significant effect of donor-to-recipient weight ratios on bilateral lung transplantation survival. A higher donor-to-recipient weight ratio was associated with improved survival after bilateral lung transplantation and likely reflects a mismatch between a relatively overweight donor vs recipient. In contrast, a lower donor-to-recipient ratio was associated with increased mortality after bilateral lung transplantation.
authors.affiliation: University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.
authors.forename: F
authors.initials: F
authors.lastname: Delom
authors.affiliation: Institut du thorax, DHU2020, INSERM UMR 1087, Service de pneumologie, CHU de Nantes, Université de Nantes, France.
authors.forename: I
authors.initials: I
authors.lastname: Danner-Boucher
authors.affiliation: Department of Thoracic and Cervical Surgery and Lung Transplantation, Haut-Levêque Hospital, Pessac, France.
authors.forename: C
authors.initials: C
authors.lastname: Dromer
authors.affiliation: Department of Thoracic and Cervical Surgery and Lung Transplantation, Haut-Levêque Hospital, Pessac, France.
authors.forename: M
authors.initials: M
authors.lastname: Thumerel
authors.affiliation: University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.
authors.forename: R
authors.initials: R
authors.lastname: Marthan
authors.affiliation: Institut du thorax, DHU2020, INSERM UMR 1087, Service de pneumologie, CHU de Nantes, Université de Nantes, France.
authors.forename: L
authors.initials: L
authors.lastname: Nourry-Lecaplain
authors.affiliation: Institut du thorax, DHU2020, INSERM UMR 1087, Service de pneumologie, CHU de Nantes, Université de Nantes, France.
authors.forename: A
authors.initials: A
authors.lastname: Magnan
authors.affiliation: Department of Thoracic and Cervical Surgery and Lung Transplantation, Haut-Levêque Hospital, Pessac, France.
authors.forename: J
authors.initials: J
authors.lastname: Jougon
authors.affiliation: University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France. Electronic address: delphine.fessart@yahoo.fr.
authors.forename: D
authors.initials: D
authors.lastname: Fessart
mesh_terms: D000328:Adult; D001835:Body Weight; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D014019:Tissue Donors; D066027:Transplant Recipients