title: Body composition and mortality after adult lung transplantation in the United States.
abstract: BACKGROUND
  Obesity and underweight are contraindications to lung transplantation based on their associations with mortality in studies performed before implementation of the lung allocation score (LAS)-based organ allocation system in the United States Objectives: To determine the associations of body mass index (BMI) and plasma leptin levels with survival after lung transplantation.
  
  
  METHODS
  We used multivariable-adjusted regression models to examine associations between BMI and 1-year mortality in 9,073 adults who underwent lung transplantation in the United States between May 2005 and June 2011, and plasma leptin and mortality in 599 Lung Transplant Outcomes Group study participants. We measured body fat and skeletal muscle mass using whole-body dual X-ray absorptiometry in 142 adult lung transplant candidates.
  
  
  RESULTS
  Adjusted mortality rates were similar among normal weight (BMI 18.5-24.9 kg/m(2)), overweight (BMI 25.0-29.9), and class I obese (BMI 30-34.9) transplant recipients. Underweight (BMI < 18.5) was associated with a 35% increased rate of death (95% confidence interval, 10-66%). Class II-III obesity (BMI ≥ 35 kg/m(2)) was associated with a nearly twofold increase in mortality (hazard ratio, 1.9; 95% confidence interval, 1.3-2.8). Higher leptin levels were associated with increased mortality after transplant surgery performed without cardiopulmonary bypass (P for interaction = 0.03). A BMI greater than or equal to 30 kg/m(2) was 26% sensitive and 97% specific for total body fat-defined obesity.
  
  
  CONCLUSIONS
  A BMI of 30.0-34.9 kg/m(2) is not associated with 1-year mortality after lung transplantation in the LAS era, perhaps because of its low sensitivity for obesity. The association between leptin and mortality suggests the need to validate alternative methods to measure obesity in candidates for lung transplantation. A BMI greater than or equal to 30 kg/m(2) may no longer contraindicate lung transplantation.
authors.affiliation: 1 Department of Medicine and.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Singer
authors.forename: Eric R
authors.initials: ER
authors.lastname: Peterson
authors.forename: Mark E
authors.initials: ME
authors.lastname: Snyder
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Katz
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Golden
authors.forename: Frank
authors.initials: F
authors.lastname: D'Ovidio
authors.forename: Matthew
authors.initials: M
authors.lastname: Bacchetta
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Sonett
authors.forename: Jasleen
authors.initials: J
authors.lastname: Kukreja
authors.forename: Lori
authors.initials: L
authors.lastname: Shah
authors.forename: Hilary
authors.initials: H
authors.lastname: Robbins
authors.forename: Kristin
authors.initials: K
authors.lastname: Van Horn
authors.forename: Rupal J
authors.initials: RJ
authors.lastname: Shah
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Diamond
authors.forename: Nancy
authors.initials: N
authors.lastname: Wickersham
authors.forename: Li
authors.initials: L
authors.lastname: Sun
authors.forename: Steven
authors.initials: S
authors.lastname: Hays
authors.forename: Selim M
authors.initials: SM
authors.lastname: Arcasoy
authors.forename: Scott M
authors.initials: SM
authors.lastname: Palmer
authors.forename: Lorraine B
authors.initials: LB
authors.lastname: Ware
authors.forename: Jason D
authors.initials: JD
authors.lastname: Christie
authors.forename: David J
authors.initials: DJ
authors.lastname: Lederer
mesh_terms: D001823:Body Composition; D015992:Body Mass Index; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D020738:Leptin / Q000097:blood; D008171:Lung Diseases / Q000097:blood / Q000150:complications / Q000601:surgery; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications; D012189:Retrospective Studies; D055948:Sarcopenia / Q000097:blood / Q000150:complications; D015996:Survival Rate; D014481:United States
chemical_list: D020738:Leptin
keywords: adiposity; biomarker; leptin; obesity; sarcopenia