Several studies have demonstrated that recipients who are underweight or obese were associated with increased in mortality after lung transplantation. However, to our knowledge, there is no study on the effect of donor body mass index (BMI) on post-transplant survival outcome. This study was conducted to understand how donor obesity, measured by donor BMI, impacts 1-year survival for lung transplant recipients. METHODS: The UNOS Standard Transplant and Analysis database was queried for patients >18 years old who received either single or double lung transplant between year 2005-2018. Donor BMI was categorized into underweight, normal weight, overweight and grades of obesity (underweight ¼ BMI <18.49, normal ¼ BMI 18.50-24.99, overweight ¼ BMI 25.00-29.99, obesity class I ¼ BMI 30.00-34.99, obesity class II-III ¼ BMI >35.00). Adjusted recipient variables were age, race, sex, BMI, smoking history, chronic steroid use, diabetes mellitus (DM) history, creatinine level at the time of transplant, ischemic time, lung allocation score (LAS) and primary lung disease (COPD, pulmonary fibrosis, cystic fibrosis and others). Adjusted donor variables were age, race, sex, alcohol history, smoking history, hypertension history and DM history. Cox regression was performed to determine adjusted hazard ratios for 1-year survival. RESULTS: A total of 15,982 patients were included in final analysis. Median recipient age was 59 and 40.4% were female. Average donor BMI was 25.9 and 45.4% were classified as normal weight. In adjusted models, improved survival was noted for patients who received lung transplantation from recipients in obesity class I (HR 0.867, 95% CI: 0.772-0.975) and obesity class II-III (HR 0.804, 95% CI: 0.688-0.941) versus recipients of normal weight. There was no statistically significant difference between underweight or overweight recipients versus those of normal weight. In adjusted recipient variables, poorer survival was noted for increased recipient age, recipient BMI categories of underweight, class I and class II-III, chronic steroid use, LAS score >80, ischemic time >6 hours, higher creatinine level (>1.5) and other primary lung disease group. In adjusted donor variables, poorer survival was noted for older donor age, male sex and presence of DM history. CONCLUSIONS: Increased donor BMI appears to confer 1-year survival benefit for lung transplant recipients. A 15% and 20% reduction in mortality were respectively seen among recipients who received transplants from class I and Class II-III obese donors. CLINICAL IMPLICATIONS: While BMI is an imperfect measurement of obesity, underlying mechanisms such as chronic adaptation to hypoxic conditions in obese population may explain an increased survival and impact donor lung selection. Further investigation is needed to further validate and understand this relationship.

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Although there are recommendations to guide patient suitability for lung transplantation (LT), referral practices remain varied across different LT centers. The goal of this project is to examine the demographic differences that exist in patients who were candidates for LT and in donors across the four regional areas of the US: Northeast (NE), Midwest (MW), South, and West.

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Several studies have demonstrated that cigarette smoking (CS) increases risk of adverse post-transplantation events such as transplantation-related complications, allograft rejections and death. Current guideline for lung transplant recipients labels active smoking as absolute contraindication for transplantation. This study was conducted to understand the effect of number of pack-years (PK-Y) smoking history on 1-year survival for lung transplant recipients.