ArticleThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation2023
Body mass index percentage and survival in pediatric patients listed for lung transplantation: A modern-era multi-institutional analysis.
Article in The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 4 citations in OpenAlex.
- Future prospects of pediatric lung transplantation.JHLT open · 2026Article
- Single-Center Experience in Pediatric Lung Transplantation: Clinical Characteristics, Survival, and Post-Transplant Morbidity.Pediatric transplantation · 2026Article
- Anesthetic management for double lung transplantation in an 8-year-old male with extreme malnutrition (BMI 11.4 kg/mTranslational pediatrics · 2026Article
- Current opinion in pediatrics: pediatric lung transplantation in the 21 st century.Current opinion in pediatrics · 2026Review
- Article
- Lung transplantation in children.Turk gogus kalp damar cerrahisi dergisi · 2024Review
- Ethical implications ofFrontiers in transplantation · 2023Article
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
Abstract
backgroundPrior studies suggest that being underweight by body mass index percentiles (BMI%) or thinness grade did not affect post-transplant survival in pediatric lung transplant (LTx) recipients regardless of cystic fibrosis (CF) or non-CF diagnosis. Graft and overall survival from the time of listing was instead evaluated based on listing BMI%, the current standard of practice for BMI definitions in pediatrics, to ascertain the impact of a "severely low" subcategory.
methodsThe UNOS registry was queried for children listed for LTx (aged 2 to <18 years) from January 1986 to March 2020. BMI% at listing and transplant were calculated per CDC guidelines according to age in years, sex, and reported BMI%. Patients were divided by listing BMI%: severely low (<3rd), low (3-<5th), normal (5-<85th), overweight (85-<95th), and obese (≥95th). Kaplan-Meier curves were generated to assess differences in overall survival since listing based on BMI% classes. Cox proportional-hazards models were developed to assess risk factors for overall and graft survival, including listing BMI%, transplant listing era (≥2005), and listing age, by reporting hazard ratios (HR).
resultsListing BMI% was calculable for 1,876 patients. The proportion of patients with CF differed significantly between BMI% groups (p < 0.001). Patients listed with a non-CF diagnosis comprised 34% of those in the severely low category, and 88% of those listed with an obese BMI%. Compared to patients with a normal listing BMI%, the cohort with severely low BMI% had worse overall survival regardless of LTx (p = 0.009) and graft survival (p = 0.034). Compared to patients with a low BMI%, those with a severely low BMI% had significantly poorer graft survival as well (p = 0.040). Mean graft survival was not significantly different between groups that remained at listing BMI% vs those that improved in category despite an overall small sample size. Independent predictors of poorer survival from the time of listing include severely low vs low-normal BMI% (HR = 1.20) and listing age (HR = 1.02).
conclusionThe proportion of children listed at severely low BMI% has steadily decreased with time, yet pediatric LTx candidates listed with a severely low BMI% had poorer graft and overall survival compared to those of normal BMI%. Severely low listing BMI% was an independent prognostic factor for higher mortality risk from the time of placement on the waitlist. BMI% may be a modifiable target for improving survival regardless of transplantation.
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