Overweight Recipients Research Articles

Mitigation of Post-Transplant Mortality Risk by Appropriate Donor-to-Recipient Size Matching Using Predicted Heart Mass

<h3>Purpose</h3> Obesity is a known risk factor for post-transplant mortality. Obesity epidemic in U.S. has led to a higher prevalence of obese patients as potential heart transplant recipients. It is unclear if appropriate size matching of donor-to-recipient using predicted heart mass (PHM) can mitigate this risk among obese recipients. <h3>Methods</h3> We selected all recipients with heart transplants performed between 1995 and 2020 (n=34,812) using the United Network for Organ Sharing database to examine the risk of death in 6 separate categories of recipient's BMI (Table) according to PHM matching. PHM-based appropriate match happened when Donor PHM/Recipient PHM x 100% was within 86% to 114% whereas under- and over-match were defined as <86% and >114%, respectively. Multivariable Cox regression models were created examining long-term risk of death in appropriately matched and over-matched categories compared to under-matched category in the overall cohort and separately within each BMI group. <h3>Results</h3> Upon follow-up (mean 5.29 years), 9,810 patients died. Recipients appropriately matched to donor hearts had an 8% lower risk of death compared to recipients matched with underweight donors by PHM (Table). Compared to those who had under-matched hearts, normal or overweight recipients who received appropriately matched donor hearts based on PHM had a 10-13% lower risk of death post-transplant (Table). In addition, morbidly obese recipients who were appropriately matched with donor hearts also had a 17% lower risk of death post-transplant (borderline statistically significant p=0.06; Table). The risk of death among obese or severely obese recipients did not differ with appropriate PHM matching or over matching compared to under-matching. <h3>Conclusion</h3> Although pretransplant obesity continues to be a risk factor for death post-transplant, appropriate size matching for donor hearts by PHM may lower the risk of death compared to under-matching specifically among normal and overweight recipients.

Pre-transplant morphometry by computed tomography scan and post-transplant dialysis risk in overweight or obese kidney transplant recipients

Adipose distribution and sarcopenia could better assess kidney transplantation outcomes than body mass index (BMI) and have been poorly evaluated among obese and overweight recipients. We aimed to evaluate morphometric radiologic markers to predict post-operative dialysis within this population. We conducted a retrospective study including patients with a BMI > 25kg/m2 undergoing kidney transplantation during 5years. Subcutaneous adipose tissue surface (SAT), visceral adipose tissue surface (VAT), and psoas surface were measured on CT scans sections. A model predictive of post-transplantation dialysis was elaborated through a multivariable logistic regression and was compared to a model including only BMI. Overall, 248 patients were included whom mean (SD) BMI and age were, respectively, 29.7kg/m2 (3.6) and 56years (12.7). Of them, 83 (33.5%) needed dialysis: 14 (5.7%) for primary kidney failure and 69 (27.8%) for delayed kidney function. On multivariable analysis, SAT, VAT and deceased donor were significantly associated with post-operative dialysis (respectively, OR [95%CI]:1.6 [1.1-2.6], 1.6[1.1-2.6], and 7.5 [1.6-56]). The area under the curve of this predictive model was 0.70 versus 0.64 for a BMI-based model. High VAT and SAT were associated with post-transplantation dialysis. A predictive model based on these morphometrics could provide a better appreciation of graft recovery after transplantation among obese and overweight recipients. External validation is needed.

Body Mass Index as a Continuous Predictor of Survival after Heart Transplantation

<h3>Purpose</h3> Both underweight and overweight recipients have poor outcomes after heart transplant (HT). However, the precise threshold of body mass index (BMI) as a predictor of heightened risk is unclear. We, therefore, examined the effect of BMI on short term survival as a continuous metric. <h3>Methods</h3> We identified adult patients listed for HT between 2000 and 2018 in the Scientific Registry of Transplant Recipients with recorded BMI at the time of listing. We calculated survival at 30 days and one year after HT and constructed Cox proportional hazards regression models adjusted for known recipient and donor risks. Recipient BMI was modeled using a restricted cubic spline with knots at 18, 25, 30, and 35 kg/m² with a value of 22 used as a referent. <h3>Results</h3> 37,068 adult HT recipients were included: median (25th, 75th percentile) BMI of 27 (23, 30) kg/m², recipient age 55 (46, 62) years, 27,668 (74.6%) men, and 9,683 (26.1%) with diabetes. After risk-adjustment, Cox proportional hazards regression showed a 3% increase in both 30-day (HR 1.031, 95% CI 1.024-1.037; p<0.0001) and 1-year mortality for every unit increase in recipient BMI (HR 1.025, 95% CI 1.022-1.033; p<0.0001). When modeled as a cubic spline, BMIs below 22 kg/m² had a neutral effect on both 30-day and 1-year mortality (although with wide confidence bars), with mortality risk steadily increasing in a non-linear fashion (Figure). <h3>Conclusion</h3> Increases in recipient BMI was associated with an incremental risk of 30-days and 1-year mortality following HT.

Surgical complications risk in obese and overweight recipients for kidney transplantation: a predictive morphometric model based on sarcopenia and vessel-to-skin distance.

Sarcopenia or adipose tissue distribution within obese and overweight renal transplanted have been poorly evaluated. Our objective was to evaluate morphometric markers to predict surgical complications in kidney transplantation. We retrospectively included patients with a BMI > 25kg/m2 undergoing kidney transplantation from 2012 to 2017. Following measurements were performed on CT-scan sections: Sub-cutaneous Adipose Tissue surface (SAT), Visceral Adipose Tissue surface (VAT), Vessel-to-Skin distance (VSK), Abdominal Perimeter (AP), and Psoas surface. A multivariable logistic regression model with BMI was compared to a model containing morphometric variables to determine the best predictive model for surgical complications. 248 patients were included, 15 (6%) experienced transplant nephrectomy, 18 (7.3%) urinary leakage, and 29 (11.7%) subcapsular renal hematoma. Multivariable logistic regression evidenced that sarcopenia and VSK were risk factors of surgical complication within a year post-transplantation (respectively, OR = 0.9, 95%CI (0.8-0.9), p = 0.04 and OR = 1.2, 95%CI (1.1-1.3), p = 0.002). Area under the curve for a predictive model including VSK, age and psoas surface was 0.69, whereas BMI model was 0.65. Combined morphometric parameters of obesity were associated with surgical complications in kidney transplantation. Morphometric threshold may provide a more accurate and objective criteria than BMI to evaluate kidney transplantation outcomes. External validation is needed.

PD22-01 ASSESSMENT OF THE RISK OF POOR RENAL FUNCTION RECOVERY AFTER TRANSPLANTATION USING MORPHOMETRIC CRITERIA IN A POPULATION OF OBESE AND OVERWEIGHT PATIENTS

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I (PD22)1 Apr 2020PD22-01 ASSESSMENT OF THE RISK OF POOR RENAL FUNCTION RECOVERY AFTER TRANSPLANTATION USING MORPHOMETRIC CRITERIA IN A POPULATION OF OBESE AND OVERWEIGHT PATIENTS Ugo Pinar*, Arthur Mageau, Xavier Rod, Yohann Renard, Jacques Irani, Benoit Barrou, and Thomas Bessede Ugo Pinar*Ugo Pinar* More articles by this author , Arthur MageauArthur Mageau More articles by this author , Xavier RodXavier Rod More articles by this author , Yohann RenardYohann Renard More articles by this author , Jacques IraniJacques Irani More articles by this author , Benoit BarrouBenoit Barrou More articles by this author , and Thomas BessedeThomas Bessede More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000872.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Except for BMI and clinical exam, few tools can evaluate and predict kidney transplantation outcomes within obese patients population. Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) are new tools to define obesity that have been poorly evaluated in kidney transplantation. Some studies suggest that the ratio VAT/SAT is correlated to post-transplantation graft function. The objective was to evaluate new morphometric markers of obesity to foresee graft function in kidney transplantation METHODS: A retrospective monocentric study from 2012 to 2017 included all patients with a BMI greater than 25 who had been transplanted. Based on a semi-automatic Hounsfield density detection sofware, the following measurements were performed on CT-scans section at L3 and L4 levels: Sub-cutaneous Adipose Tissue surface (SAT), Visceral Adipose Tissue surface (VAT), Vessel-to-Skin distance (VSK), Abdominal Perimeter (AP), Psoas surface, Skeletal Muscle Index (SMI). A univariate ROC-analysis was performed for each measure and for BMI. A multivariable logistic model of all the measurements was performed. Relevant variables were determined by the backward elimination procedure RESULTS: 248 patients were included. Their mean (SD) characteristics were: BMI = 29,68 (3,63) kg/m2, Age = 56,01 (12,67) years and cold ischemia time (CIT) = 15,4 (7,9). 14 patients (5,65%) had a primary graft failure and 69 patients (27,82%) had a delayed graft function. Bad graft function was significantly associated with BMI, VAT, SAT, AP, VSK and CIT. On multivariate analysis, SAT and VAT remained significant. The area under the curve (AUC) for a model including VAT, SAT and CIT was 0,69 (fig 1) CONCLUSIONS: VAT and SAT are associated with postoperative graft function in kidney transplantation within obese or overweight recipients. Combined in a morphometric tool, they were predictive of post-transplantation graft function. This model was more efficient than a model including BMI alone. Source of Funding: The authors declare no funding or conflicts of interests © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e459-e459 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ugo Pinar* More articles by this author Arthur Mageau More articles by this author Xavier Rod More articles by this author Yohann Renard More articles by this author Jacques Irani More articles by this author Benoit Barrou More articles by this author Thomas Bessede More articles by this author Expand All Advertisement PDF downloadLoading ...

Incidence and Risk Factors of Obesity in Childhood Solid-Organ Transplant Recipients.

Obesity is a significant public health concern; however, the incidence post solid-organ transplantation is not well reported. This study determined the incidence and risk factors of obesity among pediatric solid-organ transplant recipients (heart, lung, liver, kidney, multiorgan) at The Hospital for Sick Children (2002-2011), excluding prevalent obesity. Follow-up occurred from transplantation until development of obesity, last follow-up, or end of study. Incidence of obesity was determined overall, by baseline body mass index, and organ group. Risk factors were assessed using Cox proportional-hazards regression. Among 410 (55% male) children, median transplant age was 8.9 (interquartile range [IQR]: 1.0-14.5) years. Median follow-up time was 3.6 (IQR: 1.5-6.4) years. Incidence of obesity was 65.2 (95% confidence interval [CI]: 52.7-80.4) per 1000 person-years. Overweight recipients had a higher incidence, 190.4 (95% CI: 114.8-315.8) per 1000 person-years, than nonoverweight recipients, 56.1 (95% CI: 44.3-71.1). Cumulative incidence of obesity 5-years posttransplant was 24.1%. Kidney relative to heart recipients had the highest risk (3.13 adjusted hazard ratio [aHR]; 95% CI: 1.53-6.40) for obesity. Lung and liver recipients had similar rates to heart recipients. Those with higher baseline body mass index (z-score; 1.72 aHR; 95% CI: 1.39-2.14), overweight status (2.63 HR; 95% CI: 1.71-4.04), and younger transplant age (y; 1.18 aHR; 95% CI: 1.12-1.25) were at highest risk of obesity. Higher cumulative steroid dosage (per 10 mg/kg) was associated with increased risk of obesity after adjustment. Among all transplanted children at The Hospital for Sick Children, 25% developed obesity within 5-years posttransplant. Kidney recipients, younger children, those overweight at transplant, and those with higher cumulative steroid use (per 10 mg/kg) were at greatest risk. Early screening and intervention for obesity are important preventative strategies.

Clinical practice guidelines for the provision of renal service in Hong Kong: Potential Kidney Transplant Recipient Wait-listing and Evaluation, Deceased Kidney Donor Evaluation, and Kidney Transplant Postoperative Care.

Clinical practice guidelines for the provision of renal service in Hong Kong: Potential Kidney Transplant Recipient Wait-listing and Evaluation, Deceased Kidney Donor Evaluation, and Kidney Transplant Postoperative Care.

Impact of sarcopenic overweight on the outcomes after living donor liver transplantation.

The effect of body composition disturbances has been recently in focus. Sarcopenic obesity, a co-occurrence of low muscle mass and high body fat was reportedly predictive of high mortality in patients with cirrhosis. However, the impact of the interacting sarcopenia and overweight on the outcomes after liver transplantation is still unclear. We evaluated 200 patients undergoing adult-to-adult living donor liver transplantation at our institution between January 2008 and November 2013 classified according to BMI and psoas muscle index (PMI) on admission to transplant into 4 subgroups; sarcopenic overweight (SO), sarcopenic non-overweight (SN), non-sarcopenic overweight and non-sarcopenic non-overweight (NN). Short-term outcomes and overall post-transplant survival were compared among the four subgroups. Sarcopenic patients with preoperative low PMI had higher incidence of postoperative bacteremia and major postoperative complications, and poorer overall post-transplant survival than non-sarcopenic patients with normal/high PMI (P<0.001, respectively). Overweight recipients had a significantly higher overall survival (OS) rate than non-overweight patients (P=0.021). SO subgroup (low PMI and BMI ≥25) had statistically indifferent incidence of postoperative bacteremia, major postoperative complications or overall post-transplant survival than other recipients. In contrast, SN subgroup (low PMI and BMI <25) had higher incidence of postoperative bacteremia (P<0.001), major postoperative complications (P<0.001) than the SO subgroup and possessed the poorest OS among the four recipient subgroups (P=0.001). In living donor liver transplantation, preoperative SO did not confer added significant morbidity or mortality risks than the stand-alone sarcopenia.

Horizontal mixture model for competing risks: a method used in waitlisted renal transplant candidates.

When a patient is registered on renal transplant waiting list, she/he expects a clear information on the likelihood of being transplanted. Nevertheless, this event is in competition with death and usual models for competing events are difficult to interpret for non-specialists. We used a horizontal mixture model. Data were extracted from two French dialysis and transplantation registries. The "Ile-de-France" region was used for external validation. The other patients were randomly divided for training and internal validation. Seven variables were associated with decreased long-term probability of transplantation: age over 40years, comorbidities (diabetes, cardiovascular disease, malignancy), dialysis longer than 1year before registration and blood groups O or B. We additionally demonstrated longer mean time-to-transplantation for recipients under the age of 50, overweight recipients, recipients with blood group O or B and with pre-transplantation anti-HLA class I or II immunization. Our model can be used to predict the long-term probability of transplantation and the time in dialysis among transplanted patients, two easily interpretable parts. Discriminative capacities were validated on both the internal and external (AUC at 5years=0.72, 95% CI from 0.68 to 0.76) validation samples. However, calibration issues were highlighted and illustrated the importance of complete re-estimation of the model for other countries. We illustrated the ease of interpretation of horizontal modelling, which constitutes an alternative to sub-hazard or cause-specific approaches. Nevertheless, it would be useful to test this in practice, for instance by questioning both the physicians and the patients. We believe that this model should also be used in other chronic diseases, for both etiologic and prognostic studies.

Effect of the Obesity Epidemic on Kidney Transplantation: Obesity Is Independent of Diabetes as a Risk Factor for Adverse Renal Transplant Outcomes.

BackgroundObesity is a growing epidemic in most developed countries including the United States resulting in an increased number of obese patients with end-stage renal disease. A previous study has shown that obese patients with end-stage renal disease have a survival benefit with transplantation compared with dialysis. However, due to serious comorbidities, many centers place restrictions on the selection of obese patients for transplantation. Further, due to obese patients having an increased risk of diabetes, it is unclear whether obesity can be an independent risk, independent of diabetes for increasing adverse renal transplant outcomes.MethodsTo investigate the role of obesity in kidney transplantation, we used the Scientific Registry of Transplant Recipients database. After filtering for subjects that had the full set of covariates including age, gender, graft type, ethnicity, diabetes, peripheral vascular disease, dialysis time and time period of transplantation for our analysis, 191,091 subjects were included in the analyses. Using multivariate logistic regression analyses adjusted for covariates we determined whether obesity is an independent risk factor for adverse outcomes such as delayed graft function, acute rejection, urine protein and graft failure. Cox regression modeling was used to determine hazard ratios of graft failure.ResultsUsing multivariate model analyses, we found that obese patients have significantly increased risk of adverse transplant outcomes, including delayed graft function, graft failure, urine protein and acute rejection. Cox regression modeling hazard ratios showed that obesity also increased risk of graft failure. Life-table survival curves showed that obesity may be a risk factor independent of diabetes mellitus for a shorter time to graft failure.ConclusionsA key observation in our study is that the risks for adverse outcome of obesity are progressive with increasing body mass index. Furthermore, pre-obese overweight recipients compared with normal weight recipients also had increased risks of adverse outcomes related to kidney transplantation.

Recipient body mass index and age interact to impact survival after heart transplantation.

Although recipient body mass index (BMI) and age are known risk factors for mortality after heart transplantation, how they interact to influence survival is unknown. Our study utilized the UNOS registry from 1997 to 2012 to define the interaction between BMI and age and its impact on survival after heart transplantation. Recipients were stratified by BMI: underweight (<18.5), normal weight (18.5-24.99), overweight (25-29.99), and either moderate (30-34.99), severe (35-39.99), or very severe (≥40) obesity. Recipients were secondarily stratified based on age: 18-40 (younger recipients), 40-65 (reference group), and ≥65 (advanced age recipients). Among younger recipients, being underweight was associated with improved adjusted survival (HR 0.902; p=0.010) while higher mortality was seen in younger overweight recipients (HR 1.260; p=0.005). However, no differences in adjusted survival were appreciated in underweight and overweight advanced age recipients. Obesity (BMI≥30) was associated with increased adjusted mortality in normal age recipients (HR 1.152; p=0.021) and even more so with young (HR 1.576; p<0.001) and advanced age recipients (HR 1.292; p=0.001). These results demonstrate that BMI and age interact to impact survival as age modifies BMI-mortality curves, particularly with younger and advanced age recipients.

Robotic-assisted pancreas transplantation

To analyze the current status of robotic-assisted pancreas transplantation as a treatment option for diabetic patients. Pancreas transplant recipients continue to suffer high rates of technical complications, including wound infections, fascial dehiscence, and postoperative ventral hernias. Robotic technology can potentially contribute to decreasing these dangerous complications and improve the postoperative course of pancreas transplantation. Current literature on both robotic pancreas and robotic kidney transplant were reviewed in order to determine feasibility, safety, and efficacy of robotic pancreas transplantation. To date, only three cases of robotic pancreas transplantation, two of which were solely pancreas transplantation and one combined pancreas-kidney transplantation, have been reported in a single publication by an Italian group. Their preliminary data show that robotic pancreas transplantation is feasible and well tolerated. The authors believe that robotic pancreas transplantation could have a prominent role in lone pancreas transplantation performed in overweight recipients, in parallel to their experience with fully robotic kidney transplant in morbidly obese candidates. Broader experience with this innovative approach will be necessary to establish if robotic pancreas transplantation will be a beneficial option for diabetic patients needing beta-cell replacement.

Impact of being overweight on outcomes of hematopoietic SCT: a meta-analysis

The impact of being overweight on outcome after hematopoietic SCT (HSCT) is controversial. We performed meta-analyses to evaluate the impact of being overweight on acute graft-versus-host disease (aGVHD) risk and survival. Original data were obtained from MEDLINE, and studies that evaluated being overweight before transplantation in recipients as a risk factor for aGVHD or a prognostic factor for overall survival (OS) were extracted. Study-specific relative risks on the log scale comparing overweight with non-overweight patients were used to obtain a pooled RR with 95% confidence interval (CI). We identified 8 studies of aGVHD and 21 of OS. In allogeneic HSCT, the meta-analysis determined statistically significant associations of overweight recipients with aGVHD risk and OS. Meta-analysis of the 8 studies of aGVHD indicated that the RR for overweight to non-overweight patients was 1.186 (95% CI: 1.072-1.312). Regarding OS, meta-analysis of 11 allogeneic HSCT studies indicated that the RR for overweight to non-overweight patients was 1.163 (1.009-1.340). Our results indicate that being overweight before transplantation in recipients is associated with a high aGVHD rate and worse survival after allogeneic HSCT. Potential heterogeneity especially in adult/pediatric patients limits the interpretability of our finding. Further, well-designed large cohort studies are warranted.

Long-term management of the successful adult liver transplant: 2012 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation

Michael R. Lucey, Norah Terrault, Lolu Ojo, J. Eileen Hay, James Neuberger, Emily Blumberg, and Lewis W. Teperman Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Gastroenterology Division, Department of Medicine, University of California San Francisco, San Francisco, CA; Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI; Mayo Clinic, Rochester, MN; Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom; Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, PA; and Department of Surgery, NYU Transplant Associates, New York, NY

Increased Morbidity in Overweight and Obese Liver Transplant Recipients - A Single Centre Experience with 1325 Patients

Introduction: Various studies from US and elsewhere have reported either similar outcome between obese and non-obese liver transplant recipients, or increased morbidity and overall poor patient and graft survival in obese patients. We aim to study the impact of BMI following adult liver transplantation. Methods: Data was retrieved from a prospectively maintained institutional database from 1994-2009. Patients were stratified into 4 BMI categories established by the WHO: underweight (< 18.5 kg/m2), normal weight (18.5 to < 25.0 kg/m2), over weight (>25.0 to < 30.0 kg/m2) and obese (>30.0 kg/m2). Primary outcome was to evaluate post-operative morbidity and secondary measures were overall patient and graft survival. Categorical variables were analysed by Χ2, and continuous variables by one-way ANOVA (p value < 0.05 was considered statistically significant). Kaplan Meier curves with log-rank comparison were used to study the effect of BMI categories on patient and graft survival. Results: 1400 adult transplants were identified. 1325 patients with available date were included, of which there were 47 underweight (3.5%), 643 normal weight (48.5%), 417 overweight (31.5%) and 218 obese (16.5%) patients. Post-operative chest infections were much more common in obese (14.2% vs 9.0%, p=0.038) and overweight recipients (17.7% vs 9.0%, p < 0.001) in comparison to normal weight recipients. Obese patients had significantly longer intensive care stay than normal weight patients (mean 4.1 vs 3.2 days, p=0.043). The length of post-operative hospital stay was significantly longer in obese (mean 21.5 days, p=0.009) and overweight patients (mean 22.4 days, p=0.000) in comparison to normal weight patients (mean 18.0 days). Similarly, ascitic or drain fluid sepsis was common in overweight patients in comparison to normal weight recipients (16.5 % vs 2.2%, p< 0.001). Overall, post-operative septic events were common in overweight (60.6%, p=0.001) and obese patients (61.0%, p=0.007) in comparison to normal weight patients (50.4%). There was no difference in overall graft survival (p=0.222) and patient survival (p=0.196) between the four groups by log-rank (Mantel-Cox). Conclusions: This is the largest and the only reported UK series on BMI and outcome following liver transplantation. Liver transplantation does lead to increased morbidity in terms of septic complications in overweight and obese patients, with consequent increased length of intensive care and hospital stay. Identifying these patients early and reducing BMI appropriately should be an important consideration to improve outcomes and for appropriate use of scarce resources.

OC-058 Increased morbidity in overweight and obese liver transplant recipients—a single centre experience with 1325 patients

IntroductionObesity levels in the UK have risen over the years. Studies from the US and elsewhere have reported variable outcomes in terms of post liver transplant morbidity, mortality and graft...

Obesity and Underweight Are Associated with an Increased Risk of Death after Lung Transplantation

Obesity is considered a relative contraindication to lung transplantation, based on studies that have not accounted for key confounders. Little is known about the risk of death for underweight candidates after transplantation. To examine the associations of pretransplant obesity and underweight with the risk of death after lung transplantation. We examined 5,978 adults with cystic fibrosis, chronic obstructive pulmonary disease, and diffuse parenchymal lung disease who underwent lung transplantation in the United States between 1995 and 2003. We used Cox models and generalized additive models to examine the association between pretransplant body mass index and the risk of death after lung transplantation with adjustment for donor and recipient factors. The median follow-up time was 4.2 years. Compared with normal weight recipients, the multivariable-adjusted rates of death were 15% higher for underweight recipients (95% confidence interval, 3 to 28%), 15% higher for overweight recipients (95% confidence interval, 6 to 26%), and 22% higher for obese recipients (95% confidence interval, 8 to 39%). These relationships persisted when stratified by diagnosis. The multivariable-adjusted population attributable fraction was 12% at 1 year and 8% at 5 years. Both obesity and underweight are independent risk factors for death after lung transplantation, contributing to up to 12% of deaths in the first year after transplantation. Primary care providers and pulmonologists should promote a healthy weight for patients with lung disease long before transplantation is considered.

P95: Adjustable gastric banding (AGB) in pre-transplant patients

Morbid obesity remains a strong risk factor limiting cardiac and liver transplantation. Furthermore, studies have demonstrated that morbidly obese transplant recipients have nearly twice the 5-year mortality of normal-weight or overweight recipients, thereby preventing morbidly obese patients from undergoing a heart or liver transplant. We compare the use of AGB as a mode of weight loss for patients considering heart and liver transplant surgery.

Body mass index as a predictive factor for long‐term renal transplant outcomes in Asians

There is substantial evidence that renal transplant recipients with obesity or body mass index >30 kg/m(2) have increased risk of graft loss. However, few data exist for Asian population; clinicians have to rely upon indirect evidence by extrapolating the results from Caucasians to Asian recipients. Using data from a study population of 150 consecutive cadaveric or living related Chinese renal transplant recipients at our center between 1985 and 2002, we examined the effect of baseline body mass index cut-off 25 kg/m(2) on the transplant outcomes using Kaplan-Meier analysis and Cox proportional hazards analysis. Primary study end point was overall graft survival. The mean body mass index was 22.9 +/- 4.0 kg/m(2). Thirty-seven (25%) patients were classified as overweight and 113 patients as non-overweight, using the cut-off of 25 kg/m(2). After median follow up period of nine yr, 15 graft losses (41%) occurred in the overweight group, as compared with 14 graft losses (12%) in the non-overweight group. Kaplan-Meier estimates of cumulative graft survival at five yr were significantly worse for the overweight group than non-overweight group (83.6% versus 92.7%, p = 0.0041). By multivariate Cox proportional hazards analysis, baseline body mass index > or =25 kg/m(2) conferred a significantly higher risk of graft loss (with relative risk of 4.78, 95% CI = 1.52-15.2) and doubling of serum creatinine (relative risk 3.19, 95% CI = 1.22-8.40). Death with a functioning graft occurred in 11% of overweight recipients, compared with 3% among the non-overweight group (p = 0.041). Our results draw attention to a recipient body mass index cut-off value > or =25 kg/m(2), which might confer an increased risk of graft loss in Asian kidney transplant populations.