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Body mass index and its effect on outcome in children after lung transplantation
Christian Benden1, Deborah A Ridout, Leah B Edwards
1Division of Pulmonary Medicine, University Hospital Zurich, Switzerland. christian_benden@yahoo.de
Insights
Pediatric lung transplant recipients with cystic fibrosis (CF) often have low body mass index (BMI), but underweight status does not impact survival. However, overweight or obese children undergoing lung transplants face increased mortality risk.
Area of Science:
- Pediatric Pulmonology
- Transplant Surgery
- Nutritional Science
Background:
- Malnutrition is prevalent in pediatric lung transplant candidates, especially those with cystic fibrosis (CF).
- The impact of body mass index (BMI) on outcomes following pediatric lung transplantation remains unclear.
- This study investigates the relationship between BMI and post-transplant outcomes in children.
Purpose of the Study:
- To determine the effect of body habitus, categorized by BMI, on survival rates in pediatric lung transplant recipients.
- To compare outcomes between underweight, normal weight, overweight, and obese pediatric lung transplant recipients, stratified by CF status.
Main Methods:
- Utilized the International Society for Heart and Lung Transplantation Registry on Pediatric Lung Transplantation data (1990-2008).
- Included primary pediatric lung transplant recipients (<18 years).
- Classified recipients into BMI cohorts (thinness grades 1-3, normal, overweight, obese) using International Obesity Task Force criteria and analyzed survival rates.
Main Results:
- A total of 897 recipients were analyzed; 63% had CF.
- CF recipients exhibited a higher incidence of thinness (59%) compared to non-CF recipients (39%).
- Underweight CF recipients showed no significant difference in survival compared to normal-weight CF recipients. Overweight/obese non-CF recipients had a significantly increased risk of death (HR 2.05, p=0.002).
Conclusions:
- High rates of underweight status are observed in pediatric lung transplant recipients with CF.
- Underweight body habitus was not associated with poorer survival in CF children post-lung transplantation.
- Overweight and obese pediatric lung transplant recipients demonstrated reduced survival rates.
Background:
Malnutrition is common in children undergoing lung transplantation, particularly among those with cystic fibrosis (CF). However, the effect of body habitus on outcome after pediatric lung transplantation is unknown. We studied body mass index (BMI) and its effect on outcome in pediatric lung transplantation.
Methods:
The International Society for Heart and Lung Transplantation Registry on Pediatric Lung Transplantation was queried for primary pediatric lung transplant recipients (aged<18 years) between 1990 and 2008. BMI cohorts were defined according to International Obesity Task Force cutoffs: thinness grade 3, BMI<16 kg/m(2); thinness grade 2, 16 to<17 kg/m(2); thinness grade 1, 17 to<18.5 kg/m(2); normal, 18.5 to<25 kg/m(2); overweight, 25 to<30 kg/m(2); and obese, ≥ 30 kg/m(2). Survival was compared among BMI cohorts within CF and non-CF recipient groups.
Results:
Included were 897 recipients. The median age at transplantation was 14 years (interquartile, 11, 16 years) and 63% had CF. The incidence of thinness was 59% in CF vs 39% in non-CF patients (p<0.001). A significant proportion of CF patients were underweight, whereas more non-CF patients were obese. Cox regression showed neither underweight nor overweight CF recipients differed in survival compared with recipients of normal-weight recipients. Grade of thinness was not related to outcome after transplantation. For non-CF recipients, being overweight/obese increased risk of death compared with normal-weight recipients (hazard ratio, 2.05; 95% confidence interval, 1.28-3.26; p = 0.002).
Conclusion:
The incidence of underweight status amongst pediatric lung transplant recipients with CF is high. However, we did not find a significant negative effect of underweight body habitus on survival in CF children after lung transplantation. Overweight pediatric recipients appear to have poorer survival after transplant.
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