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Underweight Patients With Cystic Fibrosis Have Acceptable Survival Following Lung Transplantation: A United Network

Kathleen J Ramos¹, Siddhartha G Kapnadak¹, Miranda C Bradford²

¹Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Division of Pulmonary and Sleep Medicine, University of Washington, Seattle, WA.

|January 21, 2020

Insights

Underweight cystic fibrosis (CF) patients undergoing lung transplantation (LTx) have comparable survival rates to normal-weight CF patients and other lung transplant recipients. Low BMI should not be an absolute contraindication for LTx in CF patients.

Area of Science:

Pulmonology
Transplant Surgery
Medical Statistics

Background:

Reduced body mass index (BMI) is often a contraindication for lung transplantation (LTx) in the United States.
This study investigates post-LTx survival in underweight cystic fibrosis (CF) patients (BMI < 17 kg/m²).
Survival is compared to normal-weight CF patients and other common lung transplant cohorts.

Purpose of the Study:

To quantify post-LTx survival in underweight CF patients.
To compare survival rates between underweight and normal-weight CF patients.
To assess the risk of mortality in underweight CF patients relative to other transplant populations.

Main Methods:

Utilized United Network for Organ Sharing Registry data (June 2005-November 2015).
Calculated Kaplan-Meier estimates for median posttransplant survival.
Employed Cox regression modeling to assess mortality risk, comparing underweight CF patients to COPD recipients.

Main Results:

Median posttransplant survival: CF (7.9 years), COPD (5.9 years), IPF (5.5 years).
Underweight CF patients (BMI < 17 kg/m²) showed no increased mortality risk compared to normal-weight CF patients (aHR, 1.09; P = .38).
No significant difference in posttransplant mortality was observed between underweight CF patients and COPD recipients (aHR, 1.04; P = .71).

Conclusions:

Lung transplant recipients with CF and a BMI < 17 kg/m² demonstrate comparable post-LTx survival rates.
These survival rates are similar to other frequently transplanted patient groups.
A BMI < 17 kg/m² should not be considered an absolute contraindication for LTx in the CF population.

Read full analysis

Abstract

Background:

Reduced BMI is an absolute contraindication for lung transplantation (LTx) at most centers in the United States. The objective of this study was to quantify post-LTx survival of moderate to severely underweight patients with cystic fibrosis (CF) (BMI < 17 kg/m²) in the United States relative to normal-weight recipients with CF and other frequently transplanted patient cohorts.

Methods:

Using United Network for Organ Sharing Registry data (undergoing transplant from June 2005-November 2015), Kaplan-Meier estimates of median posttransplant survival were calculated for all patients with CF, COPD, and idiopathic pulmonary fibrosis (IPF), as well as low and normal weight CF subgroups. Cox regression modeling stratified according to transplant center assessed risk of posttransplant mortality in recipients with CF and a BMI < 17 kg/m² compared with recipients with COPD (reference).

Results:

Median posttransplant survival (95% CI) for CF, COPD, and IPF was 7.9 (7.2-8.6), 5.9 (5.6-6.2), and 5.5 (5.2-5.8) years, respectively. Although an absolute decrease was noted in posttransplant survival for recipients with CF and a BMI < 17 kg/m², compared with those with CF and a BMI ≥ 17 kg/m² (7.0 years [4.5-7.9] vs 8.2 years [7.3-9.0]), Cox modeling found no increased mortality risk (adjusted hazard ratio, 1.09; 95% CI, 0.90-1.32; P = .38). There was no difference in posttransplant mortality between patients with CF and a BMI < 17 kg/m² and recipients with COPD and all BMIs (adjusted hazard ratio, 1.04; 95% CI, 0.86-1.25; P = .71).

Conclusions:

Transplant recipients with CF and a BMI < 17 kg/m² had posttransplant survival rates comparable to those of other groups frequently undergoing transplantation. BMI < 17 kg/m² as a single risk factor in the CF population should not be treated as an absolute contraindication to LTx.

Keywords:

BMI cystic fibrosis lung transplant survival underweight

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