title: Underweight and obesity increase the risk of mortality after lung transplantation: a systematic review and meta-analysis.
abstract: Many studies have found an association between abnormal body mass index (BMI) and poor outcomes among lung transplant recipients. We performed a systematic review and meta-analysis to identify outcomes associated with an abnormal pretransplant BMI after lung transplantation (LTx). The MEDLINE and EMBASE databases were searched from inception to May 2015 with focus on original observational studies with post-transplant survival data in candidates with abnormal BMI (underweight, overweight, or obese). We performed meta-analyses examining survival and primary graft dysfunction after LTx. We identified 866 citations; 13 observational cohort studies involving 40 742 participants met our inclusion criteria for systematic review. Seven of the 13 were included in the meta-analysis. There was a significant risk of mortality after LTx in candidates with underweight and obesity (underweight versus normal, relative risk [RR] 1.36, 95% confidence interval [CI] 1.11-1.66, I(2)  = 0%; obesity vs. normal, RR 1.90, 95% CI 1.45-2.56, I(2)  = 0%; overweight vs. normal, RR 1.36, 95% CI 1.11-1.66, I(2)  = 0). There was also a significant risk of primary graft dysfunction in obese (RR 1.92, 95% CI 1.39-2.65, I(2)  = 0%) and overweight (RR 1.72, 95% CI, 1.32-2.24, I(2)  = 0%) candidates. Lung transplant candidates who are underweight or obese have a higher risk of post-transplant mortality than recipients with a normal BMI.
authors.affiliation: Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY, USA.|Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Sikarin
authors.initials: S
authors.lastname: Upala
authors.affiliation: Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Theppharit
authors.initials: T
authors.lastname: Panichsillapakit
authors.affiliation: Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY, USA.
authors.forename: Karn
authors.initials: K
authors.lastname: Wijarnpreecha
authors.affiliation: Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA.
authors.forename: Veeravich
authors.initials: V
authors.lastname: Jaruvongvanich
authors.affiliation: Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY, USA.|Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Anawin
authors.initials: A
authors.lastname: Sanguankeo
mesh_terms: D015992:Body Mass Index; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality*; D009765:Obesity / Q000401:mortality; D064887:Observational Studies as Topic; D013851:Thinness / Q000401:mortality
keywords: body mass index; lung transplantation; obesity; primary graft dysfunction; underweight