title: Obese patients with idiopathic pulmonary fibrosis have a higher 90-day mortality risk with bilateral lung transplantation.
abstract: BACKGROUND
  Obese patients with idiopathic pulmonary fibrosis (IPF) have higher 90-day mortality after lung transplantation. We sought to determine whether body mass index (BMI) differentially modified the effect of transplant procedure type on 90-day mortality in IPF patients.
  
  
  METHODS
  We analyzed data from the Organ Procurement and Transplantation Network (OPTN) for all patients with IPF who were transplanted between 2000 and 2010. Post-transplant survival was examined using Kaplan-Meier estimates. Multivariable logistic regression modeling was used to determine the difference in 90-day survival. The primary variable of interest was the interaction term between body mass index (BMI) and transplant type.
  
  
  RESULTS
  A total of 3,389 (58% single-lung transplant [SLT] and 42% bilateral lung transplant [BLT]) subjects were included. Multivariable logistic regression modeling demonstrated a statistically significant interaction between BMI and transplant type (p = 0.047). Patients with a BMI > 30 kg/m(2) who received a BLT are 1.71 times (95% CI [1.03 to 2.85], p = 0.038) more likely to die within 90 days than BLT recipients with a BMI of 18.5 to 30 kg/m(2).
  
  
  CONCLUSIONS
  Our results suggest that obese patients who receive a BLT may be at higher risk of 90-day mortality compared with patients of normal weight. Further study is needed to obtain more detailed information about comorbidities and other risk factors for early death that are not included in the OPTN database.
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine. Electronic address: griescj@upmc.edu.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Gries
authors.affiliation: Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Sudha
authors.initials: S
authors.lastname: Bhadriraju
authors.affiliation: Division of Pulmonary and Critical Care Medicine, VA Puget Sound Healthcare System, Seattle, Washington.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Edelman
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Goss
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Raghu
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Mulligan
mesh_terms: D000368:Aged; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011184:Postoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014861:Washington / Q000453:epidemiology
keywords: body mass index; idiopathic pulmonary fibrosis; lung transplantation; obesity; transplant type