Key result
Extreme BMI post-lung transplant linked to poorer physical QoL and increased depression versus normal BMI.
Why the study?
Obesity is associated with worse patient-centered outcomes in chronic respiratory disease, but whether this association exists in lung transplant recipients is unknown.
Are extremes of BMI associated with poorer physical health and increased depression in lung transplant recipients 5 years post-transplant?
Are extremes of BMI associated with poorer physical health and increased depression in lung transplant recipients 5 years post-transplant?
In lung transplant recipients 5 years post-transplant, both low and high BMI are associated with poorer self-perceived physical quality of life and greater depression.
Rationale Obesity is associated with worse patient-centered outcomes (PCOs) in chronic respiratory disease; whether this is also true in lung transplant recipients is unknown. A better understanding of how obesity is associated with PCOs could elucidate roles for anti-obesity treatments to improve mental and physical quality of life (QoL) as well as reduce depression, disability, or frailty after lung transplant. Methods We performed a cross-sectional analysis of adult lung transplant recipients enrolled in the Lung Transplant Outcomes Group cohort at 7 US centers. Subjects were included if they completed the Short Physical Performance Battery (SPPB) or at least one questionnaire: Short Form-12 (SF-12), Lung Transplant Valued Life Activities (LT-VLA), Patient Health Questionnaire-8 (PHQ-8) 5 +/- 1 years post-transplant. We used mixed effects linear regression with linear splines to evaluate the association between body mass index (BMI) as a continuous variable and physical health-related QoL (HRQoL, SF-12 PCS), mental HRQoL (SF-12 MCS), disability (LT-VLA), depression (PHQ-8), and frailty (SPPB) adjusted for age, sex, transplant diagnosis, time from transplant, and highest education level based on a directed acyclic graph. Results One hundred sixty-seven subjects had available, concurrent PCO and BMI data 5 +/- 1 years post-transplant. PCOs were completed a median (interquartile range, IQR) of 5.0 (4.5-5.5) years post-transplant. Subjects were 59% male, 57 (45-64) years of age at transplant, with median BMI 26.3 (22.9-30.7) kg/m2 at PCO completion. Transplant diagnoses were 53% ILD, 28% COPD, 13% CF, and 6% PVD. Both high and low BMI seemed to be associated with poorer physical health and increased depression. Relative to a subject with a BMI of 24 kg/m2, a subject with a BMI of 18.5 kg/m2 had significantly lower SF-12 PCS (-4.93, 95% CI -9.73 to -0.14) indicating poorer physical QoL and higher PHQ-8 (1.75, 95% CI -0.25 to 3.75) indicating more depressive symptoms. Relative to a subject with a BMI of 24 kg/m2, a subject with a BMI of 34 kg/m2 had lower SF-12 PCS (-1.28, 95% CI -4.56 to 2.01) and significantly higher PHQ-8 (2.40, 95% CI 1.05 to 3.74). BMI was not associated with disability, frailty, or mental HRQoL. Conclusion In a multi-center cohort of lung transplant recipients alive 5 years after transplant, both low and high BMI seem to be associated with poorer self-perceived physical QoL and greater depression. Further work is required to understand whether treating obesity can improve these patient-centered outcomes.
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Fishman et al. (2026) studied this question. Body mass index extremes 5 years post-lung transplant were associated with poorer physical quality of life (-4.93 for BMI 18.5) and increased depression (+2.40 for BMI 34) versus a BMI of 24.
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