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Trends, Determinants, and Impact on Survival of Post-Lung Transplant Weight Changes

A Single-center Longitudinal Retrospective Study

Jomphe, Valérie RD, MSc, CNSC1; Nguyen, Cécile RD2; Durette, Gabrielle RD2; Chagnon, Miguel MSc3; Nasir, Basil MD1,4; Poirier, Charles MD1,5; Ferraro, Pasquale MD1,4; Lands, Larry C. MD6,7; Mailhot, Geneviève PhD2,8

doi: 10.1097/TP.0000000000002696
Original Clinical Science—General
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Background. Weight gain is commonly seen in lung transplant (LTx) recipients. Although previous studies have focused on weight changes at fixed time periods and relatively early after transplant, trends over time and long-term weight evolution have not been described in this population. The study objectives were to document weight changes up to 15 years post-LTx and assess the predictors of post-LTx weight changes and their associations with mortality.

Methods. Retrospective cohort study of LTx recipients between January 1, 2000, and November 30, 2016 (n = 502). Absolute weight changes from transplant were calculated at fixed time periods (6 mo, 1, 2, 5, 10, and 15 y), and continuous trends over time were generated. Predictors of weight changes and their association with mortality were assessed using linear and Cox regression analysis.

Results. LTx recipients experienced a gradual increase in weight, resulting from the combination of multiple weight trajectories. Interstitial lung disease diagnosis negatively predicted post-LTx weight changes at all time points, whereas transplant body mass index categories were significant predictors at earlier time points. Patients with a weight gain of >10% at 5 years had a better survival (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.20-0.66), whereas a 10% weight loss at earlier time points was associated with worse survival (1 y: HR, 2.04; 95% CI, 1.22-3.41 and 2 y: HR, 2.37; 95% CI, 1.22-4.58).

Conclusions. Post-LTx weight changes display various trajectories, are predicted to some extent by individual and LTx-related factors, and have a negative or positive impact on survival depending on the time post-LTx. These results may lead to a better individualization of weight management after transplant.

1 Lung Transplant Program, Centre Hospitalier de l’Université de Montréal, Montreal, Canada.

2 Department of Nutrition, Faculty of Medicine, Université de Montreal, Montreal, Canada.

3 Department of Mathematics and Statistics, Université de Montréal, Montreal, Canada.

4 Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montreal, Canada.

5 Department of Medicine, Centre Hospitalier de l’Université de Montréal, Montreal, Canada.

6 Department of Pediatrics, Montreal Children’s Hospital-McGill University Health Centre, Meakins Christie Laboratories, Research Institute of the McGill University Health Centre, Montreal, Canada.

7 Respiratory Medicine, Centre Hospitalier de l’Universite de Montreal, Montreal, Canada.

8 CHU Sainte-Justine Research Centre, Montreal, Canada.

Received 7 June 2018. Revision received 1 February 2019.

Accepted 20 February 2019.

G.M. is a scholar from Fonds de Recherche du Québec en Santé. The other authors declare no conflicts of interest.

This study was supported by Alfonso Minicozzi and Family Chair in Thoracic Surgery and Lung Transplantation at the University of Montreal.

V.J., C.N., G.D., and G.M. participated in research conception and design. All authors participated in data acquisition, analysis, and interpretation. All authors participated in drafting the paper or revising it critically. All authors are involved in the final approval of the version to be published. All authors are accountable for all aspects of the work.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Correspondence: Valérie Jomphe, RD, MSc, CNSC, Lung Transplant Program, Centre Hospitalier de l’Université de Montréal, 900 Saint-Denis St (Pavillon R), Montreal, QC, Canada, H2X 0A9. (valerie.jomphe.chum@ssss.gouv.qc.ca).

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