{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:33:57Z","timestamp":1792107237366,"version":"4.4.0"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2014,11,1]],"date-time":"2014-11-01T00:00:00Z","timestamp":1414800000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Obesity and underweight are contraindications to lung transplantation based on their associations with mortality in studies performed before implementation of the lung allocation score (LAS)\u2013based organ allocation system in the United States<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine the associations of body mass index (BMI) and plasma leptin levels with survival after lung transplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used multivariable-adjusted regression models to examine associations between BMI and 1-year mortality in 9,073 adults who underwent lung transplantation in the United States between May 2005 and June 2011, and plasma leptin and mortality in 599 Lung Transplant Outcomes Group study participants. We measured body fat and skeletal muscle mass using whole-body dual X-ray absorptiometry in 142 adult lung transplant candidates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Adjusted mortality rates were similar among normal weight (BMI 18.5\u201324.9 kg\/m2), overweight (BMI 25.0\u201329.9), and class I obese (BMI 30\u201334.9) transplant recipients. Underweight (BMI &amp;lt; 18.5) was associated with a 35% increased rate of death (95% confidence interval, 10\u201366%). Class II\u2013III obesity (BMI \u2265 35 kg\/m2) was associated with a nearly twofold increase in mortality (hazard ratio, 1.9; 95% confidence interval, 1.3\u20132.8). Higher leptin levels were associated with increased mortality after transplant surgery performed without cardiopulmonary bypass (P for interaction = 0.03). A BMI greater than or equal to 30 kg\/m2 was 26% sensitive and 97% specific for total body fat\u2013defined obesity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A BMI of 30.0\u201334.9 kg\/m2 is not associated with 1-year mortality after lung transplantation in the LAS era, perhaps because of its low sensitivity for obesity. The association between leptin and mortality suggests the need to validate alternative methods to measure obesity in candidates for lung transplantation. A BMI greater than or equal to 30 kg\/m2 may no longer contraindicate lung transplantation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201405-0973oc","type":"journal-article","created":{"date-parts":[[2014,9,18]],"date-time":"2014-09-18T16:54:02Z","timestamp":1411059242000},"page":"1012-1021","source":"Crossref","is-referenced-by-count":122,"title":["Body Composition and Mortality after Adult Lung Transplantation in the United States"],"prefix":"10.1093","volume":"190","author":[{"given":"Jonathan P.","family":"Singer","sequence":"first","affiliation":[{"name":"Department of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric R.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E.","family":"Snyder","sequence":"additional","affiliation":[{"name":"Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia P.","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Golden","sequence":"additional","affiliation":[{"name":"Department of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"D\u2019Ovidio","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Physicians and Surgeons, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Bacchetta","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Physicians and Surgeons, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua R.","family":"Sonett","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Physicians and Surgeons, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasleen","family":"Kukreja","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary","family":"Robbins","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Physicians and Surgeons, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Van Horn","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Physicians and Surgeons, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupal J.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua M.","family":"Diamond","sequence":"additional","affiliation":[{"name":"Department of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Wickersham","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Hays","sequence":"additional","affiliation":[{"name":"Department of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selim M.","family":"Arcasoy","sequence":"additional","affiliation":[{"name":"Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott M.","family":"Palmer","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine B.","family":"Ware","sequence":"additional","affiliation":[{"name":"Department of Medicine, and"},{"name":"Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason D.","family":"Christie","sequence":"additional","affiliation":[{"name":"Department of Medicine and"},{"name":"Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Lederer","sequence":"additional","affiliation":[{"name":"Department of Medicine"},{"name":"Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2014,11,1]]},"reference":[{"key":"2026032100293234200_bib1","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/j.healun.2013.08.007","article-title":"The Registry of the International Society for Heart and Lung Transplantation: thirtieth adult lung and heart-lung transplant report\u20132013; 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