Michaela R Anderson1, Jayaram K Udupa2, Ethan Edwin3, Joshua M Diamond4, Jonathan P Singer5, Jasleen Kukreja6, Steven R Hays5, John R Greenland5, Anthony Ferrante3, Matthew Lippel1, Tatiana Blue1, Amika McBurnie1, Michelle Oyster4, Laurel Kalman4, Melanie Rushefski4, Caiyun Wu2, Gargi Pednekar2, Wen Liu1, Selim Arcasoy1, Joshua Sonett7, Frank D'Ovidio7, Matthew Bacchetta8, John D Newell9, Drew Torigian2, Edward Cantu10, Donna L Farber11, Jon T Giles1, Yubing Tong2, Scott Palmer12, Lorraine B Ware13, Wayne W Hancock14, Jason D Christie4, David J Lederer15. 1. Department of Medicine, Columbia University Medical Center, New York, New York. 2. Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania. 3. Columbia Institute of Human Nutrition, Columbia University Medical Center, New York, New York. 4. Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 5. Department of Medicine University of California at San Francisco, San Francisco, California. 6. Department of Surgery, University of California at San Francisco, San Francisco, California. 7. Department of Surgery, Columbia University Medical Center, New York, New York. 8. Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. 9. Department of Radiology, University of Iowa, Iowa City, Iowa. 10. Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. 11. Department of Surgery, University of California at San Francisco, San Francisco, California; Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York; Department of Microbiology and Immunology, Columbia University Medical Center, New York, New York. 12. Department of Medicine, Duke University & Duke Clinical Research Institute, Durham, North Carolina. 13. Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. 14. Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 15. Department of Medicine, Columbia University Medical Center, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, New York. Electronic address: davidlederer@columbia.edu.
Abstract
BACKGROUND: Obesity is associated with an increased risk of primary graft dysfunction (PGD) after lung transplantation. The contribution of specific adipose tissue depots is unknown. METHODS: We performed a prospective cohort study of adult lung transplant recipients at 4 U.S. transplant centers. We measured cross-sectional areas of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) on chest and abdominal computed tomography (CT) scans and indexed each measurement to height.2 We used logistic regression to examine the associations of adipose indices and adipose classes with grade 3 PGD at 48 or 72 hours, and Cox proportional hazards models to examine survival. We used latent class analyses to identify the patterns of adipose distribution. We examined the associations of adipose indices with plasma biomarkers of obesity and PGD. RESULTS: A total of 262 and 117 subjects had available chest CT scans and underwent protocol abdominal CT scans, respectively. In the adjusted models, a greater abdominal SAT index was associated with an increased risk of PGD (odds ratio 1.9, 95% CI 1.02-3.4, p = 0.04) but not with survival time. VAT indices were not associated with PGD risk or survival time. A greater abdominal SAT index correlated with greater pre- and post-transplant leptin (r = 0.61, p < 0.001, and r = 0.44, p < 0.001), pre-transplant IL-1RA (r = 0.25, p = 0.04), and post-transplant ICAM-1 (r = 0.25, p = 0.04). We identified 3 latent patterns of adiposity. The class defined by high thoracic and abdominal SAT had the greatest risk of PGD. CONCLUSIONS: Subcutaneous, but not visceral, adiposity is associated with an increased risk of PGD after lung transplantation.
BACKGROUND:Obesity is associated with an increased risk of primary graft dysfunction (PGD) after lung transplantation. The contribution of specific adipose tissue depots is unknown. METHODS: We performed a prospective cohort study of adult lung transplant recipients at 4 U.S. transplant centers. We measured cross-sectional areas of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) on chest and abdominal computed tomography (CT) scans and indexed each measurement to height.2 We used logistic regression to examine the associations of adipose indices and adipose classes with grade 3 PGD at 48 or 72 hours, and Cox proportional hazards models to examine survival. We used latent class analyses to identify the patterns of adipose distribution. We examined the associations of adipose indices with plasma biomarkers of obesity and PGD. RESULTS: A total of 262 and 117 subjects had available chest CT scans and underwent protocol abdominal CT scans, respectively. In the adjusted models, a greater abdominal SAT index was associated with an increased risk of PGD (odds ratio 1.9, 95% CI 1.02-3.4, p = 0.04) but not with survival time. VAT indices were not associated with PGD risk or survival time. A greater abdominal SAT index correlated with greater pre- and post-transplant leptin (r = 0.61, p < 0.001, and r = 0.44, p < 0.001), pre-transplant IL-1RA (r = 0.25, p = 0.04), and post-transplant ICAM-1 (r = 0.25, p = 0.04). We identified 3 latent patterns of adiposity. The class defined by high thoracic and abdominal SAT had the greatest risk of PGD. CONCLUSIONS: Subcutaneous, but not visceral, adiposity is associated with an increased risk of PGD after lung transplantation.
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