Severe underweight decreases the survival rate in adult lung transplantation

Surg Today. 2017 Oct;47(10):1243-1248. doi: 10.1007/s00595-017-1508-8. Epub 2017 Mar 17.

Abstract

Purpose: 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/m2 had 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/m2 should be used instead of BMI <18.5 kg/m2.

Keywords: Body mass index (BMI); Lung transplantation; Sarcopenia; Survival; Underweight.

MeSH terms

  • Adult
  • Body Mass Index*
  • Female
  • Humans
  • Lung Transplantation / mortality*
  • Male
  • Middle Aged
  • Nutritional Status
  • Retrospective Studies
  • Survival Rate
  • Thinness / physiopathology*