At least 7 papers have reported an increase in risk of death after lung transplantation, mostly in the first year. For this reason, obesity is a soft contraindication to lung transplantation at many centers.
David Lederer et al sought to parse out how much of that signal might be due to primary graft dysfunction, and obesity’s contribution to PGD. They performed a case-control study on 512 enrollees in the 9-center NIH-funded Lung Transplant Outcomes Group Study. They identified 40 cases of primary graft dysfunction and 80 controls.
Results: Obesity was associated with a twofold risk of primary graft dysfunction after adjusting for covariates (risk ratio 2.1). For each increase of 5 in the BMI (e.g., 31 to 36 kg/m2), the risk of PGD went up 40%. They conclude that obesity is an independent risk factor for primary graft dysfunction after lung transplantation, and may contribute to the increased mortality seen in the first year after transplant in obese people.
Lederer DJ et al. Obesity and Primary Graft Dysfunction after Lung Transplantation. Am J Respir Crit Care Med 2011;184:1055-1061.