Division of Pulmonary Medicine, University Hospital Zurich, Switzerland.
J Heart Lung Transplant. 2013 Feb;32(2):196-201. doi: 10.1016/j.healun.2012.11.002. Epub 2012 Nov 28.
Malnutrition is common in children undergoing lung transplantation, particularly among those with cystic fibrosis (CF). However, the effect of body habitus on outcome after pediatric lung transplantation is unknown. We studied body mass index (BMI) and its effect on outcome in pediatric lung transplantation.
The International Society for Heart and Lung Transplantation Registry on Pediatric Lung Transplantation was queried for primary pediatric lung transplant recipients (aged<18 years) between 1990 and 2008. BMI cohorts were defined according to International Obesity Task Force cutoffs: thinness grade 3, BMI<16 kg/m(2); thinness grade 2, 16 to<17 kg/m(2); thinness grade 1, 17 to<18.5 kg/m(2); normal, 18.5 to<25 kg/m(2); overweight, 25 to<30 kg/m(2); and obese, ≥ 30 kg/m(2). Survival was compared among BMI cohorts within CF and non-CF recipient groups.
Included were 897 recipients. The median age at transplantation was 14 years (interquartile, 11, 16 years) and 63% had CF. The incidence of thinness was 59% in CF vs 39% in non-CF patients (p<0.001). A significant proportion of CF patients were underweight, whereas more non-CF patients were obese. Cox regression showed neither underweight nor overweight CF recipients differed in survival compared with recipients of normal-weight recipients. Grade of thinness was not related to outcome after transplantation. For non-CF recipients, being overweight/obese increased risk of death compared with normal-weight recipients (hazard ratio, 2.05; 95% confidence interval, 1.28-3.26; p = 0.002).
The incidence of underweight status amongst pediatric lung transplant recipients with CF is high. However, we did not find a significant negative effect of underweight body habitus on survival in CF children after lung transplantation. Overweight pediatric recipients appear to have poorer survival after transplant.
营养不良在接受肺移植的儿童中很常见，尤其是囊性纤维化（CF）患儿。然而，身体形态对儿科肺移植后结果的影响尚不清楚。我们研究了体重指数（BMI）及其对儿科肺移植的影响。
国际心肺移植学会儿科肺移植登记处检索了 1990 年至 2008 年间进行的原发性儿科肺移植受者（年龄<18 岁）。根据国际肥胖问题工作组的切点，将 BMI 分为以下几类：消瘦 3 级，BMI<16 kg/m(2)；消瘦 2 级，16 至<17 kg/m(2)；消瘦 1 级，17 至<18.5 kg/m(2)；正常，18.5 至<25 kg/m(2)；超重，25 至<30 kg/m(2)；肥胖，≥30 kg/m(2)。在 CF 和非 CF 受者组内比较 BMI 组之间的存活率。
共纳入 897 例受者。移植时的中位年龄为 14 岁（四分位距，11、16 岁），63%为 CF。CF 患者消瘦发生率为 59%，而非 CF 患者为 39%（p<0.001）。相当一部分 CF 患者体重不足，而非 CF 患者则肥胖。Cox 回归显示，与体重正常的受者相比，消瘦或超重的 CF 受者存活率无差异。消瘦程度与移植后结果无关。对于非 CF 受者，与体重正常的受者相比，超重/肥胖受者死亡风险增加（危险比，2.05；95%置信区间，1.28-3.26；p = 0.002）。
CF 患儿肺移植受者体重不足发生率较高。然而，我们并未发现 CF 儿童肺移植后消瘦体型对生存有显著负面影响。超重的儿科受者移植后存活率较低。
