Snell G I, Bennetts K, Bartolo J, Levvey B, Griffiths A, Williams T, Rabinov M
Lung and Heart Transplant Service, Alfred Hospital, Prahran, Victoria, Australia.
J Heart Lung Transplant. 1998 Nov;17(11):1097-103.
The timing of referral and listing for lung transplantation in adults with cystic fibrosis is influenced by many factors including pulmonary function, body mass index (BMI), sex, and patient and physician choice. This study aimed to analyze the effect of these variables on waiting list and postoperative mortality rates. In particular, low BMI is suggested to portend a poor outcome after transplantation.
All patients with cystic fibrosis referred to our institution (n = 92) between 1989 and 1996 were reviewed, and the effect on survival of BMI, sex, and other covariates was analyzed by use of Cox proportional hazards regression.
Forty-five transplantations were undertaken with a mean waiting time of 226 days (range 1 to 678). Fifteen of the 62 listed patients died before transplantation with a mean time to death of 160 days (range 8 to 533). Fifteen patients died after transplantation. BMI at the time of listing predicted waiting list mortality (P < .05). Female sex tended to increase waiting list mortality rates, such that the combination of BMI less than 18 kg/m2, and female sex was associated with a 21% 1-year waiting list survival without transplantation. Age, forced expiratory volume in 1 second, sex, BMI, and date of transplantation did not predict postoperative survival.
Patients with cystic fibrosis (particularly women) referred for lung transplantation with a BMI less than 18 kg/m2 are at high risk of death over the next 12 months. With this in mind, they should not be denied transplantation unduly while attempts are made to increase weight, especially because pretransplantation BMI does not influence posttransplantation survival.
成年囊性纤维化患者肺移植的转诊和列入等待名单的时间受到多种因素影响，包括肺功能、体重指数（BMI）、性别以及患者和医生的选择。本研究旨在分析这些变量对等待名单和术后死亡率的影响。特别是，低BMI被认为预示着移植后预后不良。
回顾了1989年至1996年间转诊至本机构的所有囊性纤维化患者（n = 92），并使用Cox比例风险回归分析BMI、性别和其他协变量对生存的影响。
共进行了45例移植，平均等待时间为226天（范围1至678天）。62例列入等待名单的患者中有15例在移植前死亡，平均死亡时间为160天（范围8至533天）。15例患者在移植后死亡。列入等待名单时的BMI可预测等待名单死亡率（P <.05）。女性性别往往会增加等待名单死亡率，因此BMI低于18 kg/m²且为女性的患者，未移植情况下1年等待名单生存率为21%。年龄、第1秒用力呼气量、性别、BMI和移植日期不能预测术后生存率。
转诊进行肺移植的BMI低于18 kg/m²的囊性纤维化患者（尤其是女性）在未来12个月内死亡风险很高。考虑到这一点，在尝试增加体重时不应过度拒绝他们进行移植，特别是因为移植前BMI不影响移植后生存率。
