Thomas Weig1, Katrin Milger2, Birgit Langhans3, Silke Janitza4, Alma Sisic5, Klaus Kenn6, Thomas Irlbeck1, Andreas Pomschar3, Thorsten Johnson3, Michael Irlbeck1, Jürgen Behr2, Stephan Czerner1, René Schramm7, Hauke Winter8, Claus Neurohr2, Lorenz Frey1, Nikolaus Kneidinger9. 1. Department of Anesthesiology, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL). 2. Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL). 3. Institute for Clinical Radiology, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL). 4. Department of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL). 5. Transplant Center Munich, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL). 6. Department of Respiratory Medicine, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany, Member of the German Center for Lung Research (DZL). 7. Clinic of Cardiac Surgery, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL). 8. Department of Thoracic Surgery, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL). 9. Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL). Electronic address: nikolaus.kneidinger@med.uni-muenchen.de.
Abstract
BACKGROUND: Careful patient selection is the prerequisite to raise transplant benefit. In lung transplant (LT) candidates, the effect of body mass index (BMI) on postoperative outcome remains controversial, possibly due to the inaccuracy of BMI in discriminating between fat and muscle mass. We therefore hypothesized that assessment of body composition by muscle mass measures is more accurate than by BMI regarding postoperative outcome. METHODS: All LT recipients from 2011 to 2014 were included and retrospectively analyzed. Lean psoas area (LPA) was assessed from pretransplant computed tomography scans, and associations with postoperative outcomes were investigated. RESULTS: Included were 103 consecutive LT recipients with a mean pre-LT BMI of 22.0 ± 4.0 kg/m(2) and a mean LPA of 22.3 ± 8.3 cm(2). LPA was inversely associated with length of mechanical ventilation (p = 0.03), requirement of tracheostomy (p = 0.035), and length of stay in the intensive care unit (p = 0.02), while controlling for underlying disease, BMI, sex, age, and procedure; in contrast, BMI was not (p = 0.25, p = 0.54, and p = 0.42, respectively.). Multiple regression analysis revealed that the 6-minute walk distance at the end of pulmonary rehabilitation was significantly associated with LPA (p = 0.02). CONCLUSIONS: LPA can easily be assessed in LT candidates as part of pretransplant evaluation and was significantly associated with short-term outcome, whereas BMI was not. Assessment of LPA may provide additional information on body composition beyond BMI. However, the clinical utility has to be further evaluated.
BACKGROUND: Careful patient selection is the prerequisite to raise transplant benefit. In lung transplant (LT) candidates, the effect of body mass index (BMI) on postoperative outcome remains controversial, possibly due to the inaccuracy of BMI in discriminating between fat and muscle mass. We therefore hypothesized that assessment of body composition by muscle mass measures is more accurate than by BMI regarding postoperative outcome. METHODS: All LT recipients from 2011 to 2014 were included and retrospectively analyzed. Lean psoas area (LPA) was assessed from pretransplant computed tomography scans, and associations with postoperative outcomes were investigated. RESULTS: Included were 103 consecutive LT recipients with a mean pre-LT BMI of 22.0 ± 4.0 kg/m(2) and a mean LPA of 22.3 ± 8.3 cm(2). LPA was inversely associated with length of mechanical ventilation (p = 0.03), requirement of tracheostomy (p = 0.035), and length of stay in the intensive care unit (p = 0.02), while controlling for underlying disease, BMI, sex, age, and procedure; in contrast, BMI was not (p = 0.25, p = 0.54, and p = 0.42, respectively.). Multiple regression analysis revealed that the 6-minute walk distance at the end of pulmonary rehabilitation was significantly associated with LPA (p = 0.02). CONCLUSIONS:LPA can easily be assessed in LT candidates as part of pretransplant evaluation and was significantly associated with short-term outcome, whereas BMI was not. Assessment of LPA may provide additional information on body composition beyond BMI. However, the clinical utility has to be further evaluated.
Authors: Jon Kobashigawa; Darshana Dadhania; Sangeeta Bhorade; Deborah Adey; Joseph Berger; Geetha Bhat; Marie Budev; Andres Duarte-Rojo; Michael Dunn; Shelley Hall; Meera N Harhay; Kirsten L Johansen; Susan Joseph; Cassie C Kennedy; Evan Kransdorf; Krista L Lentine; Raymond J Lynch; Mara McAdams-DeMarco; Shunji Nagai; Michael Olymbios; Jignesh Patel; Sean Pinney; Joanna Schaenman; Dorry L Segev; Palak Shah; Lianne G Singer; Jonathan P Singer; Christopher Sonnenday; Puneeta Tandon; Elliot Tapper; Stefan G Tullius; Michael Wilson; Martin Zamora; Jennifer C Lai Journal: Am J Transplant Date: 2018-12-22 Impact factor: 8.086
Authors: Jonathan P Singer; Joshua M Diamond; Michaela R Anderson; Patricia P Katz; Ken Covinsky; Michelle Oyster; Tatiana Blue; Allison Soong; Laurel Kalman; Pavan Shrestha; Selim M Arcasoy; John R Greenland; Lori Shah; Jasleen Kukreja; Nancy P Blumenthal; Imaani Easthausen; Jeffrey A Golden; Amika McBurnie; Ed Cantu; Joshua Sonett; Steven Hays; Hilary Robbins; Kashif Raza; Matthew Bacchetta; Rupal J Shah; Frank D'Ovidio; Aida Venado; Jason D Christie; David J Lederer Journal: Am J Transplant Date: 2018-05-14 Impact factor: 8.086
Authors: Michaela R Anderson; Imaani Easthausen; Grace Gallagher; Jayaram Udupa; Yubing Tong; Drew Torigian; Joshua Matthew Diamond; Mary Katherine Porteous; Scott M Palmer; Laurie D Snyder; Luke Benvenuto; Meghan Aversa; Selim Arcasoy; John R Greenland; Steven R Hays; Jasleen Kukreja; Edward Cantu; John Shinn Kim; Dympna Gallagher; Matthew R Baldwin; R Graham Barr; David J Lederer; Jason D Christie; Jonathan Paul Singer Journal: Thorax Date: 2020-06-01 Impact factor: 9.139
Authors: Michael J Pienta; Peng Zhang; Brian A Derstine; Binu Enchakalody; William B Weir; Tyler Grenda; Rebecca Goulson; Rishindra M Reddy; Andrew C Chang; Stewart C Wang; Jules Lin Journal: Ann Thorac Surg Date: 2017-12-02 Impact factor: 4.330
Authors: Carla M Prado; Sarah A Purcell; Carolyn Alish; Suzette L Pereira; Nicolaas E Deutz; Daren K Heyland; Bret H Goodpaster; Kelly A Tappenden; Steven B Heymsfield Journal: Ann Med Date: 2018-09-12 Impact factor: 4.709
Authors: Joanna M Schaenman; Joshua M Diamond; John R Greenland; Cynthia Gries; Cassie C Kennedy; Amit D Parulekar; Dmitry Rozenberg; Jonathan P Singer; Lianne G Singer; Laurie D Snyder; Sangeeta Bhorade Journal: Am J Transplant Date: 2020-12-24 Impact factor: 9.369
Authors: Tobias Veit; Dieter Munker; Gabriela Leuschner; Carlo Mümmler; Alma Sisic; Teresa Kauke; Christian Schneider; Michael Irlbeck; Sebastian Michel; Daniela Eser-Valerie; Maximilian Huber; Jürgen Barton; Katrin Milger; Bruno Meiser; Jürgen Behr; Nikolaus Kneidinger Journal: PLoS One Date: 2020-06-18 Impact factor: 3.240