Hye Yeon Jhun

Overweight-mortality paradox and impact of six-minute walk distance in lung transplantation

Overweight-mortality paradox and impact of six-minute walk distance (SMWD) in lung transplantation Background: The objective of this study was to examine combined prognostic influence of body mass index (BMI) and SMWD on mortality in lung transplant recipients. Methods: Consecutive isolated lung transplant recipients were identified. Preoperative BMI and SMWD data were collected. The cohort was followed for all-cause mortality. Results: The study included 324 lung transplant recipients with mean age of 57 ± 13 years and 58% were male (27% obstructive, 3% vascular, 6% cystic fibrosis, and 64% with restrictive lung diseases). In the total cohort; 37% had normal BMI, 10% were underweight, 33% were overweight, and 20% were obese. The median SMWD was 700 feet. The lower SMWDgroup was defined as the patients who had SMWD <237 feet as determined by receiver operating characteristic (ROC). Based on this definition, 66 patients (20%) had lower SMWD. There were 71 deaths during a median follow-up of 2.3 years. In multivariate analysis, both BMI and SMWD were independently associated with death. Being overweight was associated with reduced mortality risk (hazard ratio (HR) 0.50, P = 0.042) compared to the normal BMI group, and this was primarily driven by early mortality posttransplant. This paradoxical overweight-mortality relationship remained significant in the lower SMWD group (HR 0.075, P = 0.018), but not in the higher SMWD group (P = 0.552). Conclusion: In lung transplant recipients under lung allocation score (LAS) era, pretransplant BMI and SMWD were independent predictors for mortality after the transplant. The lowest mortality risk was noted in a group of transplant recipients identified as overweight; whereas, being underweight or obese was associated with increased mortality.

Impact of pre-operative coronary artery disease on cardiovascular events following lung transplantation

BACKGROUND This study examined the correlation between pre-operative coronary artery disease (CAD) and post-operative cardiovascular events in lung transplant recipients. METHODS Consecutive isolated lung transplant recipients from 2007 to 2013 in our institution were identified and categorized as having significant CAD (≥ 50% coronary stenosis in at least 1 artery or history of coronary revascularization) or no-mild CAD. Patient records and death index data were analyzed for a median of 2 years for death or cardiovascular events, including coronary, cerebrovascular, and peripheral artery events. RESULTS The study comprised 280 patients (62% male) with mean age of 60 ± 10 years. Cardiovascular events occurred in 5.7% (16 of 280) of the entire cohort. Patients with significant CAD had a higher annualized rate of cardiovascular events than those with no-mild CAD (11.9% vs 0.6%; p < 0.001). Significant CAD was an independent predictor of cardiovascular events (hazard ratio, 20.32; 95% confidence interval, 5.79-71.26; p < 0.001) but not all-cause mortality (log-rank p = 0.66). Adding significant CAD to clinical risk factors gave incremental prognostic performance compared with clinical risk factors alone (p < 0.001 for increase in global chi-square). CONCLUSION Selected lung transplant candidates with significant CAD can undergo transplantation with equal mortality risk to those without CAD but are at a higher risk of non-fatal cardiovascular events. These data support the current practice of accepting a selected group of patients with CAD for lung transplantation and suggest that they should be monitored early and treated to prevent cardiovascular complications.

CORONARY ARTERY CALCIUM SCORE AS A PREDICTOR FOR INCIDENT ISCHEMIC STROKE: SYSTEMATIC REVIEW AND META-ANALYSIS

The objective of this study was to investigate the predictive value of CACS obtained by noncontrast electrocardiogram-gated CT for incident ischemic stroke. We search Pubmed, Embase, Cochrane databases for prospective longitudinal studies of CACS which reported the incidence of ischemic stroke.

Tu1108 Pre-Transplant Proton Pump Inhibitor Is Not Associated With Improved Survival of Lung Allografts

Background Gastroesophageal reflux disease (GERD) has been identified as a possible contributor of aspiration after lung transplantation that leads to graft failure and increased mortality. This study was designed to investigate whether the usage of proton pump inhibitor (PPI) pre-transplant is associated with decreased posttransplant mortality and/or retransplant. Methods A total of 324 consecutive patients who underwent lung transplant from January 2009 to June 2012 were retrospectively reviewed. Demographic information and baseline clinical characteristics of lung transplant recipients were collected. Clinical variables were compared between patients with and without clinical events determined as all-cause mortality and/or re-transplant. Usage of PPI were analyzed between recipients with clinical events (n= 78) and those without events (n= 246). Perioperative events were defined as events that occurred within 30 days after transplant. Results The cohort comprised of 58.3% male (189 of 324) with mean age (SD) of 58(13). Majority of patients had double lung transplant (62.8%; 203 of 324). Mean (SD) follow up interval was 2.0 (1.2) year. Idiopathic pulmonary fibrosis was the leading primary lung pathology (46.9%), followed by COPD (23.1%) and cystic fibrosis (6.5%). Prevalence of GERD prior to transplant was 42% (137 of 324). Clinical events occurred in 25% (78 of 324) of the cohort (66 death and 12 retransplants). Of those, 29.5% (23 of 78) were perioperative. There was no statistically significant difference in percentage use of PPI between patients with and without events (54.7% VS 53.0% respectively; p 0.927). Subgroup analysis in patients with diagnosis of GERD pre-transplant also demonstrated no significant difference in PPI use in the two groups (78.8% VS 83.7%; p 0.522). Kaplan Meier survival analysis revealed no significant difference in both mortality (p 0.874) and overall graft survival (p 0.806) as shown in Figure 1. Conclusion Use of proton pump inhibitors prior to transplantation is not associated with increased allografts survival in lung transplant recipients. Baseline characteristics and study variables categorized by clinical events.