Risk stratification of outcomes following lung transplant by body mass index

SESSION TITLE: Outcomes and Opportunities: Lung Transplantation SESSION TYPE: Original Investigations PRESENTED ON: 10/10/2023 01:45 pm - 02:45 pm PURPOSE: Body mass index (BMI) over 30 places lung transplant recipients at increased risk of primary graft dysfunction (PGD) and post-transplant mortality when compared to normal or overweight recipients. Additional markers of body composition may not otherwise be accurately assessed by BMI. Advances in surgical technique and postoperative management may also attenuate this risk. We aim to report the outcomes of a single academic, tertiary-care hospital to assess immediate and short-term outcomes following lung transplant as stratified by BMI. METHODS: Retrospective data collection from the Cedars-Sinai Medical Center electronic medical record was performed on patients who underwent lung transplant between October 1st, 2020 and February 28th, 2022. Immediate and short-term outcomes were assessed by degree of PGD at 72 hours, 30-day survival, 90-day survival, and 1-year survival. Logistic regression analysis was performed to assess for significant difference between evidence of PGD at 72 hours as well as survival timepoints. RESULTS: A total of 71 patients were reviewed, with 69 included; 1 patient was excluded due to early graft loss from bronchial stenosis requiring repeat transplantation, and 1 patient was excluded due to unstageable PGD at 72 hours. Of these 69 patients, 33 had a BMI <25, 26 had a BMI between 25 and <30, and 10 had a BMI of 30 to <35. At one year from transplant, 28/33 (85%) of the patients with BMI <25 were alive; 25/26 (96%) with BMI between 25 and <30 were alive; and 8/10 (80%) with BMI 30 and <35 were alive. Based on our logistic regression analysis, there was no correlation between BMI and evidence of PGD at 72 hours (odds ratio (OR) of 1.1 [0.97,1.3]). Moreover, there was no significant relationship between BMI and 30-day survival, 90-day survival, and 1-year survival, with respective ORs of 1.9 (1.0, 3.8), 1.4 (0.99, 1.9), and 1.1 (0.90, 1.3). CONCLUSIONS: BMI as a risk stratification tool for evaluation of lung transplant candidacy does not consistently predict worsened patient outcomes. Transplant centers with higher levels of experience with lung transplant at higher BMI ranges may be able to attenuate risks of PGD and mortality. Further data are needed for reassessment of other forms of body composition as predictive tools for candidate selection. CLINICAL IMPLICATIONS: Patients with a higher BMI may still be considered for lung transplant candidacy at transplantcenters with increased experience with lung transplant in overweight and obese patients. DISCLOSURES: No relevant relationships by Darina Barnes No relevant relationships by Reinaldo Rampolla, value=Honoraria Removed 03/27/2023 by Reinaldo Rampolla, source=Web Response No relevant relationships by Alexander Yuen No relevant relationships by Lorenzo Zaffiri