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. 2022 Nov 1;106(11):2247-2255.
doi: 10.1097/TP.0000000000004222. Epub 2022 Jun 24.

New-onset Obesity After Lung Transplantation: Incidence, Risk Factors, and Clinical Outcomes

Valérie Jomphe  1 , Noémie Bélanger  2 , Caroline Beauchamp-Parent  2 , Charles Poirier  1   3 , Basil S Nasir  1   4 , Pasquale Ferraro  1   4 , Larry C Lands  1   5 , Geneviève Mailhot  2   6
Affiliations

New-onset Obesity After Lung Transplantation: Incidence, Risk Factors, and Clinical Outcomes

Valérie Jomphe et al. Transplantation. .

Abstract

Background: Lung transplant (LTx) recipients who gain weight after transplantation may experience an upward shift in body mass index (BMI) that places them in the obese category. The incidence, risk factors, and impact on metabolic health and mortality of new-onset obesity have not been documented in the LTx setting.

Methods: This single-center retrospective study included 564 LTx recipients. Individuals were stratified according to their BMI trajectories from pretransplant evaluation up to 10 y posttransplant. New-onset obesity was defined as a pretransplant BMI <30 kg/m 2 and posttransplant BMI >30 kg/m 2 . The incidence, risk factors, and posttransplant diabetes mellitus, metabolic syndrome, and mortality of recipients with new-onset obesity were compared with those of nonobese (BMI <30 kg/m 2 , pre/post-LTx), consistently obese (BMI >30 kg/m 2 , pre/post-LTx), and obese recipients with weight loss (BMI >30 kg/m 2 pre-LTx, BMI <30 kg/m 2 post-LTx).

Results: We found that 14% of recipients developed obesity after transplantation. Overweight individuals (odds ratio [OR]: 9.01; 95% confidence interval [CI] [4.86-16.69]; P < 0.001) and candidates with chronic obstructive pulmonary disease (OR: 6.93; 95% CI [2.30-20.85]; P = 0.001) and other diagnoses (OR: 4.28; 95% CI [1.22-14.98]; P = 0.023) were at greater risk. Multivariable regression analysis showed that new-onset obesity was associated with a greater risk of metabolic syndrome (hazard ratio: 1.70; 95% CI [1.17-2.46]; P = 0.005), but not of posttransplant diabetes mellitus, than nonobesity. Recipients with new-onset obesity had a survival comparable to that of consistently obese individuals.

Conclusions: A greater understanding of the multifaceted nature of post-LTx obesity may lead to interventions that are better tailored to the characteristics of these individuals.

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Conflict of interest statement

G.M. was a Junior 2 scholar from Fonds de recherche du Québec-Santé when this study was carried out. The other authors declare no conflicts of interest.

References

    1. Jomphe V, Nguyen C, Durette G, et al. Trends, determinants, and impact on survival of post-lung transplant weight changes: a single-center longitudinal retrospective study. Transplantation. 2019;103:2614–2623.
    1. Madill J, Gutierrez C, Grossman J, et al.; Toronto Lung Transplant Program. Nutritional assessment of the lung transplant patient: body mass index as a predictor of 90-day mortality following transplantation. J Heart Lung Transplant. 2001;20:288–296.
    1. Upala S, Panichsillapakit T, Wijarnpreecha K, et al. Underweight and obesity increase the risk of mortality after lung transplantation: a systematic review and meta-analysis. Transpl Int. 2016;29:285–296.
    1. Jomphe V, Mailhot G, Damphousse V, et al. The impact of waiting list BMI changes on the short-term outcomes of lung transplantation. Transplantation. 2018;102:318–325.
    1. Diamond JM, Lee JC, Kawut SM, et al.; Lung Transplant Outcomes Group. Clinical risk factors for primary graft dysfunction after lung transplantation. Am J Respir Crit Care Med. 2013;187:527–534.

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