Survival improved for patients with cystic fibrosis with BMI recovery post-lung transplant
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In patients with cystic fibrosis, lower preoperative BMI was linked to lower likelihood for BMI recovery within 1 year of lung transplant, but those who achieved BMI recovery within 1 year after transplant had improved survival, researchers reported.
“Poor nutritional status as measured by BMI is an independent risk factor for pre-transplant death in advanced cystic fibrosis lung disease and low BMI is an indication for early referral to a lung transplant center,” Joseph B. Pryor, MD, professor in the department of general internal medicine at the University of Washington, Seattle, and colleagues wrote in Annals of the American Thoracic Society. “Underweight status has been shown to be common in advanced cystic fibrosis lung disease, with one study demonstrating BMI <18.5 kg/m2 in 42% of cystic fibrosis transplant recipients.”
The retrospective cohort study included 1,977 lung transplant recipients with cystic fibrosis from the United Network for Organ Sharing and Cystic Fibrosis Foundation patient registries from June 2005 to December 2016. Researchers compared posttransplant 1-year conditional survival between recipients who survived 1 year or longer with low (< 17 and 17-18.49 kg/m2) and normal ( 18.5 kg/m2) preoperative BMI. This was stratified by BMI recovery.
Fourteen percent of recipients had a BMI less than 17 kg/m2 and 23% of recipients had a BMI of 17 kg/m2 to 18.49 kg/m2.
BMI recovery occurred in 29% of recipients with a preoperative BMI less than 17 kg/m2 and 49% of recipients with a preoperative BMI of 17 kg/m2 to 18.49 kg/m2 who were alive at 1 year.
Those with low preoperative BMI had worse posttransplant conditional survival at 1 year compared with recipients with a preoperative BMI of 18.5 kg/m2 or more, but those who achieved BMI recovery within 1 year had longer survival. The adjusted HR for 1-year survival was 1.29 for those with a preoperative BMI of less than 17 kg/m2 with BMI recovery compared with 1.57 for those without recovery. The adjusted HR for 1-year survival was also lower at 1.28 for those with a preoperative BMI of 17 kg/m2 to 18.49 kg/m2 with BMI recovery compared with 1.72 for those without recovery.
“Having a low preoperative BMI is a risk factor for poor outcomes after lung transplant, but this study underscores the importance of attention to BMI recovery posttransplant,” the researchers wrote. “Future research should investigate whether approaches to augment weight gain posttransplant improve outcomes, particularly among recipients with very low BMI at the time of transplant.”