It's What’s Inside that Counts: Body Composition and Lung Transplantation
Purpose of Review
Factors such as weight, body composition, and functional status appear to influence lung transplant outcomes. Body mass index (BMI) is incorporated into the International Society for Heart and Lung Transplantation’s (ISHLT) recipient selection guidelines. Data suggests BMI does not effectively differentiate patients with high body fat percentage or low lean muscle mass, leading to both over and under estimates of candidates’ risks.
Recent research has focused on alternate measures and estimates of body composition and their associations with important lung transplant outcomes. Herein, we review the current literature on body composition in lung transplantation, including the variety of measurements used and the concepts of obesity, low muscle mass, and frailty.
The concept of body composition is evolving beyond the relationship between weight and height as represented by a calculated body mass index. Radiographic assessments and serum markers allow for a more precise and representative measurement of body composition which takes into consideration fat percentage and muscle mass.
KeywordsLung transplant Body composition Body mass index Obesity Lean body mass Sarcopenia Frailty
body mass index
creatinine height index
intensive care unit
magnetic resonance imaging
whole body dual X-ray absorptiometry
CCK and EFB are supported by the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN. CCK is also supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number K23HL128859.
Compliance with Ethical Standards
Conflict of Interest
Erin Barreto is on the advisory board for FAST Biomedical, outside the submitted work. Cassie Kennedy, Anupam Kumar and Jessica Lau declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
The manuscript’s contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Weill D, Benden C, Corris PA, Dark JH, Davis RD, Keshavjee S, et al. A consensus document for the selection of lung transplant candidates: 2014—an update from the pulmonary transplantation Council of the International Society for heart and lung transplantation. J Heart Lung Transplant. 2015;34:1–15.CrossRefPubMedGoogle Scholar
- 3.• Singer JP, Peterson ER, Snyder ME, Katz PP, Golden JA, D’Ovidio F, et al. Body composition and mortality after adult lung transplantation in the United States. Am J Respir Crit Care Med. 2014;190:1012–21. This reference concluded that a BMI of 30.0–34.9 kg/m 2 is not associated with 1-year mortality after lung transplantation. It also demonstrated that BMI over and underestimates the presence of obesity (compared to DXA). CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Orens JB, Estenne M, Arcasoy S, Conte JV, Corris P, Egan JJ, et al. Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. International guidelines for the selection of lung transplant candidates: 2006 update—a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2006;25:745–55.CrossRefPubMedGoogle Scholar
- 8.• Chandrashekaran S, Keller CA, Kremers WK, et al. Weight loss prior to lung transplantation is associated with improved survival. J Heart Lung Transplant. 2015;34:651–7. Demonstrated that losing weight pre-transplant to a BMI < 30 kg/m 2 was feasible. Also demonstrated that overweight and obese patients who lost weight prior to transplant had a decreased mortality risk. CrossRefPubMedGoogle Scholar
- 16.• Kelm DJ, Bonnes SL, Jensen MD, et al. Pre-transplant wasting (as measured by muscle index) is a novel prognostic indicator in lung transplantation. Clin Transpl. 2016;30:247–55. This reference demonstrated that patients with a low measured muscle mass for body size had an associated increased risk of post-transplant mortality. CrossRefGoogle Scholar
- 21.Hoang V, Li GW, Kao CC, et al. Determinants of pre-transplantation pectoralis muscle area (PMA) and post-transplantation change in PMA in lung transplant recipients. Clin Transpl. 2017;3:1–8.Google Scholar
- 28.• Kashani KB, Sarvottam K, Pereira NL, Barreto EF, Kennedy CC. The sarcopenia index: a novel measure of muscle mass in lung transplant candidates. Clin Transpl. 2018. This reference introduced a novel measure, the sarcopenia index (SI), which utilizes blood values of creatinine and cystatin C levels to estimate body composition. Intriguing because it would be cheap and easily trended; however, further studies are required to see if SI correlates to lung transplant outcomes;32:e13182.CrossRefGoogle Scholar