BACKGROUND Obesity is associated with an increased risk of primary graft dysfunction (PGD) after lung transplantation. The contribution of specific adipose tissue depots is unknown. METHODS We performed a prospective cohort study of adult lung transplant recipients at 4 U.S. transplant centers. We measured cross-sectional areas of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) on chest and abdominal computed tomography (CT) scans and indexed each measurement to height.2 We used logistic regression to examine the associations of adipose indices and adipose classes with grade 3 PGD at 48 or 72 hours, and Cox proportional hazards models to examine survival. We used latent class analyses to identify the patterns of adipose distribution. We examined the associations of adipose indices with plasma biomarkers of obesity and PGD. RESULTS A total of 262 and 117 subjects had available chest CT scans and underwent protocol abdominal CT scans, respectively. In the adjusted models, a greater abdominal SAT index was associated with an increased risk of PGD (odds ratio 1.9, 95% CI 1.02-3.4, p = 0.04) but not with survival time. VAT indices were not associated with PGD risk or survival time. A greater abdominal SAT index correlated with greater pre- and post-transplant leptin (r = 0.61, p < 0.001, and r = 0.44, p < 0.001), pre-transplant IL-1RA (r = 0.25, p = 0.04), and post-transplant ICAM-1 (r = 0.25, p = 0.04). We identified 3 latent patterns of adiposity. The class defined by high thoracic and abdominal SAT had the greatest risk of PGD. CONCLUSIONS Subcutaneous, but not visceral, adiposity is associated with an increased risk of PGD after lung transplantation.

中文翻译：

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肺移植后脂肪组织定量和原发性移植物功能障碍：肺移植身体成分研究。


背景肥胖与肺移植后原发性移植物功能障碍（PGD）风险增加相关。特定脂肪组织库的贡献尚不清楚。方法 我们对美国 4 个移植中心的成年肺移植受者进行了一项前瞻性队列研究。我们在胸部和腹部计算机断层扫描 (CT) 扫描中测量了皮下脂肪组织 (SAT) 和内脏脂肪组织 (VAT) 的横截面积，并将每次测量结果与身高建立索引。2 我们使用逻辑回归来检查脂肪指数和内脏脂肪组织 (VAT) 之间的关联。 48 或 72 小时进行 3 级 PGD 的脂肪类别，并使用 Cox 比例风险模型来检查存活率。我们使用潜在类别分析来识别脂肪分布模式。我们检查了脂肪指数与肥胖和 PGD 血浆生物标志物的关联。结果共有 262 名受试者和 117 名受试者分别进行了胸部 CT 扫描和腹部 CT 扫描。在调整后的模型中，较大的腹部 SAT 指数与 PGD 风险增加相关（比值比 1.9，95% CI 1.02-3.4，p = 0.04），但与生存时间无关。 VAT 指数与 PGD 风险或生存时间无关。腹部 SAT 指数越高，移植前和移植后瘦素水平越高（r = 0.61，p < 0.001，r = 0.44，p < 0.001）、移植前 IL-1RA（r = 0.25，p = 0.04） ）和移植后 ICAM-1（r = 0.25，p = 0.04）。我们确定了 3 种潜在的肥胖模式。由高胸部和腹部 SAT 定义的类别具有最大的 PGD 风险。结论 皮下而非内脏肥胖与肺移植后 PGD 风险增加相关。