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Editorials |

Waiting To Make the Weight for Lung Transplantation

Stephanie M. Levine, MD, FCCP; Edward Y. Sako, MD, PhD, FCCP
Author and Funding Information

Affiliations: San Antonio, TX 
 ,  Dr. Levine is Associate Professor of Medicine and Medical Director of the Lung Transplant Program, and Dr. Sako is Associate Professor of Surgery and Surgical Director of the Lung Transplant Program, University of Texas Health Science Center at San Antonio and is associated with the South Texas Veterans Health Care System, Audie L. Murphy Memorial Veterans Hospital Division, San Antonio, TX.

Correspondence to: Stephanie M. Levine, MD, FCCP, The South Texas Veterans Health Care System, Audie L. Murphy Division, Pulmonary Section (111E), 7400 Merton Minter Blvd, San Antonio, TX 78229; e-mail: LEVINES@UTHSCSA.EDU



Chest. 2002;121(2):317-320. doi:10.1378/chest.121.2.317
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Since lack of donor organs remains the limiting factor to the number of lung transplantation procedures that can be performed, lung transplant physicians and surgeons are struggling constantly to find a balance between those patients who most need this procedure and those who are likely to have a reasonable chance for a favorable outcome. One of the areas that must be addressed in this regard is recipient body weight.

Extrapolating from data in studies from other areas of thoracic surgery, and particularly in the field of cardiac transplantation, one also would suspect that extremes of body weight may portend a worse outcome in the lung transplant recipient.13 Similar results also have been found in the kidney transplant recipient, with a demonstrated correlation between obesity and increased rates of cardiac disease, and decreased graft and patient survival.45 Little has been published on body weight in the field of lung transplantation, other than limited data examining outcomes in cachectic or nutritionally depleted patients who were undergoing lung transplantation. These data suggest that lung transplant recipients with body mass indexes (BMIs) [ie, weight in kilograms divided by the height in meters squared] lower than the 25th percentile, or < 80% of the predicted weight for a certain height, and/or those patients with lean body mass depletion have a worse survival rate following lung transplantation.8 Additionally, not all studies have reached these same conclusions.9 Until the publication of the article by Kanasky et al in this issue of CHEST (see page 401) and a recent publication by Madill et al,10 no studies had been conducted on the opposite extreme (ie, the evaluation of a morbidly obese patient for lung transplantation). Other problems that have been seen in the few studies on the extremes of body weight have been the variable definitions of obesity and the interchangeable use of measures of BMI and percentage of ideal body weight.

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