Obesity and Primary Graft Dysfunction after Lung Transplantation The Lung Transplant Outcomes Group Obesity Study

• Published in: American journal of respiratory and critical care medicine Vol. 184; no. 9; pp. 1055 - 1061
• Main Authors: Lederer, David J., Kawut, Steven M., Wickersham, Nancy, Winterbottom, Christopher, Bhorade, Sangeeta, Palmer, Scott M., Lee, James, Diamond, Joshua M., Wille, Keith M., Weinacker, Ann, Lama, Vibha N., Crespo, Maria, Orens, Jonathan B., Sonett, Joshua R., Arcasoy, Selim M., Ware, Lorraine B., Christie, Jason D.
• Format: Journal Article
• Language: English
• Published: New York, NY American Thoracic Society 01.11.2011
• Subjects: Adiponectin - blood; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biomarkers; Biomarkers - blood; Body Mass Index; Bone marrow, stem cells transplantation. Graft versus host reaction; Case-Control Studies; Chronic obstructive pulmonary disease; Cohort analysis; Confidence intervals; Edema; Female; Health risk assessment; Humans; Intensive care medicine; Laboratories; Leptin - blood; Linear Models; Logistic Models; Lung diseases; Lung Diseases, Interstitial - complications; Lung Diseases, Interstitial - surgery; Lung Transplantation - adverse effects; Lung Transplantation - mortality; Lung transplants; Male; Medical sciences; Middle Aged; Mortality; Obesity; Obesity - blood; Obesity - complications; Obesity - mortality; Odds Ratio; Overweight - blood; Overweight - complications; Plasma; Primary Graft Dysfunction - blood; Primary Graft Dysfunction - etiology; Primary Graft Dysfunction - mortality; Prospective Studies; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - surgery; Ratios; Regression analysis; Resistin - blood; Risk Factors; Severity of Illness Index; Survival Analysis; Time Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; United States; Variables; United States; Obesity; Lung disease; Intensive care; Prognosis; Respiratory disease; Nutrition disorder; acute lung injury; Leptin; lung transplantation; Graft primary dysfunction; Nutritional status; Resuscitation; primary graft dysfunction
• ISSN: 1073-449X; 1535-4970; 1535-4970
• DOI: 10.1164/rccm.201104-0728OC

Obesity has been linked to acute lung injury and is a risk factor for early mortality after lung transplantation. To examine the associations of obesity and plasma adipokines with the risk of primary graft dysfunction after lung transplantation. We performed a prospective cohort study of 512 adult lung transplant recipients with chronic obstructive pulmonary disease or interstitial lung disease enrolled in the Lung Transplant Outcomes Group Study. In a nested case-control study, we measured plasma leptin, adiponectin, and resistin before lung transplantation and 6 and 24 hours after lung transplantation in 40 cases of primary graft dysfunction and 80 control subjects. Generalized linear mixed models and logistic regression were used to estimate risk ratios and odds ratios. Grade 3 primary graft dysfunction developed within 72 hours of transplantation in 29% participants. Obesity was associated with a twofold increased risk of primary graft dysfunction (adjusted risk ratio 2.1; 95% confidence interval, 1.7-2.6). The risk of primary graft dysfunction increased by 40% (confidence interval, 30–50%) for each 5 kg/m(2) increase in body mass index after accounting for center, diagnosis, cardiopulmonary bypass, and transplant procedure. Higher plasma leptin levels were associated with a greater risk of primary graft dysfunction (sex-adjusted P = 0.02). The associations of both obesity and leptin with primary graft dysfunction tended to be stronger among those who did not undergo cardiopulmonary bypass. Obesity is an independent risk factor for primary graft dysfunction after lung transplantation.