Severe underweight decreases the survival rate in adult lung transplantation.
OBJECTIVE
The body mass index (BMI) before lung transplantation (LT) is a benchmark of the post-LT survival. The aim of the study is to determine the BMI inadequate for the post-LT survival.


METHODS
We examined the survival after LT in patients grouped into the following BMI categories: <18.5 kg/m2(underweight), 18.5-24.9 kg/m2(normal weight), 25-29.9 kg/m2(overweight), and ≥30.0 kg/m2(obese) according to the World Health Organization (WHO) criteria. A more detailed categorization was made for further evaluation of the underweight group: mild (17.0 ≤ BMI < 18.5 kg/m2) and severely underweight (BMI <17.0 kg/m2).


RESULTS
There was no statistically significant difference in the post-LT survival between underweight and normal-weight patients (5-year survival: 78.7 vs. 76.1%). Patients with BMI <17.0 kg/m2had a worse prognosis than those with 17.0 ≤ BMI < 18.5 kg/m2(5-year survival: 70.3 vs. 90.0%).


CONCLUSIONS
Standard BMI categorization per the WHO criteria is inadequate for determining the post-LT survival, especially in underweight patients. For the nutritional evaluation of underweight pre-LT patients, BMI <17.0 kg/m2should be used instead of BMI <18.5 kg/m2.
Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Teruya
T
Komatsu
Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Toyofumi F
TF
Chen-Yoshikawa
Department of Metabolism and Clinical Nutrition, Kyoto University, Kyoto, Japan.
Ayako
A
Oshima
Department of Diabetes, Endocrinology, and Nutrition, Kyoto University, Kyoto, Japan.
Shin-Ichi
SI
Harashima
Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Akihiro
A
Aoyama
Department of Diabetes, Endocrinology, and Nutrition, Kyoto University, Kyoto, Japan.
Nobuya
N
Inagaki
Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. hdate@kuhp.kyoto-u.ac.jp.
Hiroshi
H
Date
D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D012189:Retrospective Studies; D015996:Survival Rate; D013851:Thinness / Q000503:physiopathology*
Body mass index (BMI); Lung transplantation; Sarcopenia; Survival; Underweight