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The Relationship of BMI and Lung Transplant Recipients. 實習生 : 中山醫 李佳靜 指導老師 : 陳燕慈 營養師. Lung transplant. BMI. risk of mortality. Literature(1). Influence of Nutritional Status in Lung Transplant Recipients. Introduction. Serum albumin. predict malnutrition and mortality - PowerPoint PPT Presentation
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實習生 : 中山醫 李佳靜指導老師 : 陳燕慈 營養師
The Relationship of BMI and Lung Transplant
Recipients
1
Lung transplant
BMI risk of mortality
2
Literature(1)
Influence of Nutritional Status in Lung Transplant Recipients
3
Introduction
Serum albuminSerum albumin
serum prealbuminserum prealbumin
Body Mass IndexBody Mass Index
predict malnutrition and mortalityamong hospitalized patients
Purpose:post transplantation survival rates
4
MethodsBMI
Serum albuminSerum prealbumin
BMIGroup 1 <18.5
Group 2 18.5~24.9
Group 3 25~27.5
Group 4 >27.5
5
Result
6
Result
Obese patients (BMI>27.5 ) risk of mortality
Low levels of prealbumin ( level <18 gr/dL)
risk of mortality
Low levels of albumin No association about mortality
7
Conclusion
BMI>27.5
Low pretransplant prealbumin
levels
mortality
8
Literature(2)
Obesity and Underweight Are Associated with an Increased Risk of Death after Lung Transplantation
9
IntroductionObesity (BMI >30 kg/m2) is considered a
relative contraindication. Little is known about underweight(BMI
<18.5 kg/m2)
Underweight → higher risk of death after lung transplantation
1- or 5-year mortality was unknown
10
Purpose
We hypothesized that underweight and obesity would be associated with an increased risk of death after transplantation after adjustment for potential confounders.
Obesityv.s
underweight
risk of death
pretransplant after lung transplantation
11
Methods• Participants :
Included Exclude1.Recipient age >18 years 2.single or bilateral lung transplant procedure3.cystic fibrosis(CF), chronic obstructive pulmonary disease (COPD), diffuse parenchymal lung disease(DPLD).
1.Donor age < 12 years2.Recipient or donor height < 138 cm or > 198cm3.BMI <13 or >40 kg/m2
4.Unknown height or weight5.Use mechanical ventilation
12
Methods• BMI :
BMI<18.5 Underweight18.5~24.9 Normal
weight25~29.9 Overweight>30 Obese
13
MethodsThe lung allocation score (LAS) was calculated
using data obtained at the time of transplantation. The primary outcome was recipient survival,
calculated as the number of days from the date of transplantation to the date of death.
They estimated odds ratios for early death (at 1 yr) and late death (at 5 yr conditional on 1-yr survival)
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ResultMedian age=54 years
3,671 single-2,307
double-
Median LAS
=32.8
15
Result
Medium survival time
=4.8 years
16
Result17
Discussion-Obesity
Higher risk of death due to respiratory failure among obese recipients.
A risk of death : obese > overweight
obese recipients
obese recipients
1 year after LTs
odds of
death 40%
18
Discussion-Underweight
Underweight was associated with a higher risk of death after transplantation.
The greater risk of infection in underweight transplant recipients.
early mortalit
y
late mortalit
y
older populatio
n
younger recipien
ts CF
COPD
risk of death
19
Discussion-Clinical ImplicationAt the extremes of BMI may be at
particularly high risk of early or late death after transplantation.
Promote long
survival
corticosteroid withdrawal and avoidanceNutritional counseling dietary modificationbariatric surgerypulmonary rehabilitation
20
Conclusion
Primary care providers and pulmonologists should promote a healthy weight for patients with lung disease long before transplantation is considered.
Obesity
Obesity
underweight
underweight
Risk of deathRisk of death
12% of deaths in the first year
21
Literature(3)
The impact of recipient body mass index on survival after lung transplantation
22
BackgroundFew studies have examined recipient
weight and outcomes after Lung transplant (LTx). The United Network for Organ Sharing(UNOS) database provides an opportunity to examine outcomes related to body mass index (BMI) in a large cohort of LTx patients.
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MethodsData source: The UNOS data set was retrospectively
reviewed for 11,411 adult primary LTx patients (1998 to 2008)
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Methods• BMI :
BMI<18.5 Underweight18.5~24.9 Normal
weight25~29.9 Overweight>30 Obese
25
MethodsThe primary end point : all-cause mortality. Secondary outcomes : rejection episodes in
the first year and short-term mortality were also examined.
26
ResultFigure 1 Number of lung transplants performed
during the study period, stratified by body mass index categories
27
ResultFigure 2 Kaplan-Meier estimates of survival
for lung transplant recipients stratified by body mass index categories.
28
Result29
DiscussionThe increase in mortality risk was 15% for obese
patients and 14% for underweight patients.
The absolute decrease in 5-year survival was 3.0% for overweight recipients, 6.1% for obese recipients and 2.7% for underweight recipients.
30
DiscussionThe increase in mortality for overweight
and obese recipients was present as early as 30 days after LTx and persisted though all follow-up times examined.
This argues strongly that the negative effect of overweight or obese BMI manifests early after LTx.
31
ConclusionUnderweight, overweight, and obese
recipients have decreased survival compared with normal weight recipients.
For overweight and obese recipients, this survival difference is demonstrable as early as 30 days after LTx.
Underweight recipients do not manifest survival differences until 1 year after LTx.
32
SummaryObesity OverweightUnderweight
Suggest BMI of lung transplant : normal BMI : 18.5~24.9
survival
risk of mortality
33
34