Overweight-mortality paradox and impact of six-minute walk distance in lung transplantation

Kongkiat Chaikriangkrai; Hye Yeon Jhun; Edward A Graviss; Soma Jyothula

doi:10.4103/1817-1737.160835

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Overweight-mortality paradox and impact of six-minute walk distance in lung transplantation

Journal article

Open access

Peer reviewed

Overweight-mortality paradox and impact of six-minute walk distance in lung transplantation

Kongkiat Chaikriangkrai, Hye Yeon Jhun, Edward A Graviss and Soma Jyothula

Annals of thoracic medicine, Vol.10(3), pp.169-175

07/2015

DOI: 10.4103/1817-1737.160835

PMCID: PMC4518346

PMID: 26229558

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Abstract

Overweight-mortality paradox and impact of six-minute walk distance (SMWD) in lung transplantation. The objective of this study was to examine combined prognostic influence of body mass index (BMI) and SMWD on mortality in lung transplant recipients. Consecutive isolated lung transplant recipients were identified. Preoperative BMI and SMWD data were collected. The cohort was followed for all-cause mortality. The study included 324 lung transplant recipients with mean age of 57 ± 13 years and 58% were male (27% obstructive, 3% vascular, 6% cystic fibrosis, and 64% with restrictive lung diseases). In the total cohort; 37% had normal BMI, 10% were underweight, 33% were overweight, and 20% were obese. The median SMWD was 700 feet. The lower SMWDgroup was defined as the patients who had SMWD <237 feet as determined by receiver operating characteristic (ROC). Based on this definition, 66 patients (20%) had lower SMWD. There were 71 deaths during a median follow-up of 2.3 years. In multivariate analysis, both BMI and SMWD were independently associated with death. Being overweight was associated with reduced mortality risk (hazard ratio (HR) 0.50, P = 0.042) compared to the normal BMI group, and this was primarily driven by early mortality posttransplant. This paradoxical overweight-mortality relationship remained significant in the lower SMWD group (HR 0.075, P = 0.018), but not in the higher SMWD group (P = 0.552). In lung transplant recipients under lung allocation score (LAS) era, pretransplant BMI and SMWD were independent predictors for mortality after the transplant. The lowest mortality risk was noted in a group of transplant recipients identified as overweight; whereas, being underweight or obese was associated with increased mortality.

Body mass index

body composition

lung transplant

obesity paradox

six-minute walk

Details

Title: Subtitle: Overweight-mortality paradox and impact of six-minute walk distance in lung transplantation
Creators: Kongkiat Chaikriangkrai - Department of Medicine, Houston Methodist Hospital, Houston, United States
Hye Yeon Jhun - Department of Medicine, Houston Methodist Hospital, Houston, United States
Edward A Graviss - Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, United States
Soma Jyothula - Department of Medicine, Houston Methodist Hospital, Houston, United States
Resource Type: Journal article
Publication Details: Annals of thoracic medicine, Vol.10(3), pp.169-175
DOI: 10.4103/1817-1737.160835
PMID: 26229558
PMCID: PMC4518346
NLM abbreviation: Ann Thorac Med
ISSN: 1817-1737
eISSN: 1998-3557
Language: English
Date published: 07/2015
Academic Unit: Gastroenterology and Hepatology; Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984094518202771

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