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77: The Impact of Recipient Body Mass Index on Outcomes Following Lung Transplantation
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The Journal of Heart and Lung Transplantation, Vol 29, No 2S, February 2010
Conclusions: Our study identifies renal insufficiency as a significant risk factor for higher LTx mortality in preoperatively ventilated patients. Future guidelines on LTx under these circumstances should include this information. 77 The Impact of Recipient Body Mass Index on Outcomes Following Lung Transplantation J.G. Allen,1 G.J. Arnaoutakis,1 E.S. Weiss,1 C.A. Merlo,2 J.V. Conte,1 A.S. Shah.1 1Johns Hopkins Medical Institutions, Baltimore, MD; 2Johns Hopkins Medical Institutions, Baltimore, MD. Purpose: Lung transplant(LTx) candidates are frequently over or underweight. Few studies have examined the effect of recipient weight on outcomes following LTx. The United Network for Organ Sharing(UNOS) database provides an opportunity to examine outcomes related to body mass index(BMI) in a large modern cohort of LTx patients. Methods and Materials: We retrospectively reviewed the UNOS dataset for 10,057 adult primary LTx patients(1998-2007). Patients were stratified by recipient BMI strata:⬍18.5(underweight), 18.5-24.9(normal), 25.029.9(overweight), ⬎30(obese). All cause mortality was examined with Cox proportional hazard regression incorporating 15 variables. Mortality was examined using the Kaplan-Meier method(30d, 90d, 1yr, and 5yr). Results: Of 10,057, 12.3% (n⫽1237) were underweight, 44.3% (n⫽4453) were normal weight, 31.6% (n⫽3182) were overweight, and 11.8% (n⫽1185) were obese. 4034 (40%) died during the study. Mortality was significantly different between the strata at each time point examined, with incremental increases in mortality for each BMI strata above or below normal. On multivariable analysis, BMI strata predicted mortality compared to normal; underweight (Hazard ratio (HR) 1.13[1.02-1.26], p⫽0.02), overweight (HR 1.10[1.02-1.19], p⫽0.01), and obese (HR 1.14[1.02-1.27], p⫽0.02) recipients had increased risk of death. KaplanMeier modeling showed a significant effect of BMI on survival (Figure1). However, this effect was no longer significant when 1st yr deaths were excluded. Conclusions: Our study represents the largest modern cohort evaluating recipient weight in LTx. Underweight, overweight, and obese patients have higher mortality when compared to normal weight controls. However, this effect appears to be mediated by mortality in the 1st yr after LTx.[figure1]
78 WITHDRAWN 79 Insurance Status and Education Level Are Independent Predictors of Survival after Lung Transplantation J.G. Allen,1 G.J. Arnaoutakis,1 J.F. McDyer,2 J.B. Orens,2 A.S. Shah,1 C.A. Merlo.2,3 1Johns Hopkins University School of Medicine, Baltimore, MD; 2Johns Hopkins University School of Medicine, Baltimore, MD; 3 Johns Hopkins School of Public Health, Baltimore, MD.
Purpose: Socioeconomic factors such as education, race, income, and insurance status have been shown to affect health outcomes and are known to play a role in survival after heart, kidney, and liver transplantation. Despite this, little is known about the role of socioeconomic factors as predictors of survival after lung transplantation. Methods and Materials: All patients over the age of 18 years in the UNOS Registry undergoing lung transplantation during the period Jan 2000 through May 2009 were included in the study. Time-to-event analyses for risk of death after transplantation were performed using Kaplan-Meier survival and Cox proportional hazards models. Results: During the study period, there were 11,213 patients who underwent lung transplantation. The median (IQR) follow-up time was 713 (218-1448) days. The mean (SD) age was 52.0 (12.7) years, mean (SD) FEV1% predicted was 35.9 (20.9) and 45.4% were female. Of the cohort, 22.2% had a college degree or greater level of education. During the study period, 60.8% reported having private insurance, 27.5% reported having Medicare, and 7% reported having Medicaid. In bivariable analyses, recipients with higher education level had significantly improved survival (HR: 0.90, 95% CI: 0.83-0.97) when compared to recipients with lower education level. Likewise, recipients with private insurance had improved survival (HR: 0.82, 95% CI: 0.73-0.92) when compared to recipients with Medicaid. In multivariable analyses, the effect of higher education level (HR: 0.87, 95% CI: 0.80-0.95) and private insurance (HR: 0.79, 95% CI: 0.70-0.90) persisted even after adjusting for age, sex, race, diagnosis,markers of disease severity, and known predictors of survival after lung transplantation. Conclusions: Socioeconomic factors are significant predictors of survival after lung transplantation. Lung transplant recipients with higher education levels and private insurance appear to have increased survival when compared to recipients with lower education and Medicaid beneficiaries independent of racial differences. 80 Quality of Life and Predictors of Medication Adherence in Pediatric Heart Transplant Recipients K. Uzark,1 M. Zamberlan,2 P. Murphy,3 C. Nasman,4 R. Rodriguez,5 J. Dupuis,6 S. Rodgers,6 Y. Wang,1 R. Ittenbach.1 1Cincinnati Children’s Hospital Medical Ctr, Cincinnati, OH; 2University of Michigan Medical Ctr, Ann Arbor, MI; 3St Louis Children’s Hospital, St. Louis, MO; 4 Cleveland Clinic Foundation, Cleveland, OH; 5Columbia Univeristy Medical Ctr, New York, NY; 6Children’s Hospital of Michigan, Detroit, MI; 7Children’s Memorial Hospital, Chicago, IL. Purpose: While heart transplantation (HTx) has improved survival and quality of life (QOL) in children with terminal heart disease, consistent and lifelong medication (med) adherence is required to sustain these outcomes. In this multicenter study, our aim was to examine the prevalence and correlates of medication non-adherence in pediatric HTx recipients including QOL factors as perceived by patients and parents and demographic/ medical variables. Methods and Materials: The pediatric quality of life inventory core and cardiac module scales were administered to 75 children/parents (mean age 13.6 ⫾ 3.1yrs) including 33 males and 42 females, 1 to 17 yrs (mean 6.85) following HTx. Mean age at HTx was 6.73 yrs, range 10 days to 17.6 yrs. Clinicians rated medication adherence on a 4-point scale based on drug level history. Results: Adherence was rated as excellent in 57 (76%) of patients, less than excellent or incomplete adherence in 18 (24%). Lower adherence was significantly correlated with lower self-reported psychosocial QOL scores (p⫽.05) and lower self-reported treatment (barriers) scores (i.e. more perceived problems related to taking meds), r⫽.32, p⫽.006, including difficulty remembering to take meds (p⫽.03). Parental perceptions of the child’s QOL and treatment barrier scores however, were not significantly correlated with adherence. Adherence was not correlated with the child’s gender, SES, time since transplant, or number of meds taken. Patients with incomplete adherence tend to be older, p⫽.06. In a logistic regression analysis, only self-reported treatment barriers was a significant predictor of med adherence (p⫽.01).
The Journal of Heart and Lung Transplantation, Vol 29, No 2S, February 2010
Conclusions: Our study identifies renal insufficiency as a significant risk factor for higher LTx mortality in preoperatively ventilated patients. Future guidelines on LTx under these circumstances should include this information. 77 The Impact of Recipient Body Mass Index on Outcomes Following Lung Transplantation J.G. Allen,1 G.J. Arnaoutakis,1 E.S. Weiss,1 C.A. Merlo,2 J.V. Conte,1 A.S. Shah.1 1Johns Hopkins Medical Institutions, Baltimore, MD; 2Johns Hopkins Medical Institutions, Baltimore, MD. Purpose: Lung transplant(LTx) candidates are frequently over or underweight. Few studies have examined the effect of recipient weight on outcomes following LTx. The United Network for Organ Sharing(UNOS) database provides an opportunity to examine outcomes related to body mass index(BMI) in a large modern cohort of LTx patients. Methods and Materials: We retrospectively reviewed the UNOS dataset for 10,057 adult primary LTx patients(1998-2007). Patients were stratified by recipient BMI strata:⬍18.5(underweight), 18.5-24.9(normal), 25.029.9(overweight), ⬎30(obese). All cause mortality was examined with Cox proportional hazard regression incorporating 15 variables. Mortality was examined using the Kaplan-Meier method(30d, 90d, 1yr, and 5yr). Results: Of 10,057, 12.3% (n⫽1237) were underweight, 44.3% (n⫽4453) were normal weight, 31.6% (n⫽3182) were overweight, and 11.8% (n⫽1185) were obese. 4034 (40%) died during the study. Mortality was significantly different between the strata at each time point examined, with incremental increases in mortality for each BMI strata above or below normal. On multivariable analysis, BMI strata predicted mortality compared to normal; underweight (Hazard ratio (HR) 1.13[1.02-1.26], p⫽0.02), overweight (HR 1.10[1.02-1.19], p⫽0.01), and obese (HR 1.14[1.02-1.27], p⫽0.02) recipients had increased risk of death. KaplanMeier modeling showed a significant effect of BMI on survival (Figure1). However, this effect was no longer significant when 1st yr deaths were excluded. Conclusions: Our study represents the largest modern cohort evaluating recipient weight in LTx. Underweight, overweight, and obese patients have higher mortality when compared to normal weight controls. However, this effect appears to be mediated by mortality in the 1st yr after LTx.[figure1]
78 WITHDRAWN 79 Insurance Status and Education Level Are Independent Predictors of Survival after Lung Transplantation J.G. Allen,1 G.J. Arnaoutakis,1 J.F. McDyer,2 J.B. Orens,2 A.S. Shah,1 C.A. Merlo.2,3 1Johns Hopkins University School of Medicine, Baltimore, MD; 2Johns Hopkins University School of Medicine, Baltimore, MD; 3 Johns Hopkins School of Public Health, Baltimore, MD.
Purpose: Socioeconomic factors such as education, race, income, and insurance status have been shown to affect health outcomes and are known to play a role in survival after heart, kidney, and liver transplantation. Despite this, little is known about the role of socioeconomic factors as predictors of survival after lung transplantation. Methods and Materials: All patients over the age of 18 years in the UNOS Registry undergoing lung transplantation during the period Jan 2000 through May 2009 were included in the study. Time-to-event analyses for risk of death after transplantation were performed using Kaplan-Meier survival and Cox proportional hazards models. Results: During the study period, there were 11,213 patients who underwent lung transplantation. The median (IQR) follow-up time was 713 (218-1448) days. The mean (SD) age was 52.0 (12.7) years, mean (SD) FEV1% predicted was 35.9 (20.9) and 45.4% were female. Of the cohort, 22.2% had a college degree or greater level of education. During the study period, 60.8% reported having private insurance, 27.5% reported having Medicare, and 7% reported having Medicaid. In bivariable analyses, recipients with higher education level had significantly improved survival (HR: 0.90, 95% CI: 0.83-0.97) when compared to recipients with lower education level. Likewise, recipients with private insurance had improved survival (HR: 0.82, 95% CI: 0.73-0.92) when compared to recipients with Medicaid. In multivariable analyses, the effect of higher education level (HR: 0.87, 95% CI: 0.80-0.95) and private insurance (HR: 0.79, 95% CI: 0.70-0.90) persisted even after adjusting for age, sex, race, diagnosis,markers of disease severity, and known predictors of survival after lung transplantation. Conclusions: Socioeconomic factors are significant predictors of survival after lung transplantation. Lung transplant recipients with higher education levels and private insurance appear to have increased survival when compared to recipients with lower education and Medicaid beneficiaries independent of racial differences. 80 Quality of Life and Predictors of Medication Adherence in Pediatric Heart Transplant Recipients K. Uzark,1 M. Zamberlan,2 P. Murphy,3 C. Nasman,4 R. Rodriguez,5 J. Dupuis,6 S. Rodgers,6 Y. Wang,1 R. Ittenbach.1 1Cincinnati Children’s Hospital Medical Ctr, Cincinnati, OH; 2University of Michigan Medical Ctr, Ann Arbor, MI; 3St Louis Children’s Hospital, St. Louis, MO; 4 Cleveland Clinic Foundation, Cleveland, OH; 5Columbia Univeristy Medical Ctr, New York, NY; 6Children’s Hospital of Michigan, Detroit, MI; 7Children’s Memorial Hospital, Chicago, IL. Purpose: While heart transplantation (HTx) has improved survival and quality of life (QOL) in children with terminal heart disease, consistent and lifelong medication (med) adherence is required to sustain these outcomes. In this multicenter study, our aim was to examine the prevalence and correlates of medication non-adherence in pediatric HTx recipients including QOL factors as perceived by patients and parents and demographic/ medical variables. Methods and Materials: The pediatric quality of life inventory core and cardiac module scales were administered to 75 children/parents (mean age 13.6 ⫾ 3.1yrs) including 33 males and 42 females, 1 to 17 yrs (mean 6.85) following HTx. Mean age at HTx was 6.73 yrs, range 10 days to 17.6 yrs. Clinicians rated medication adherence on a 4-point scale based on drug level history. Results: Adherence was rated as excellent in 57 (76%) of patients, less than excellent or incomplete adherence in 18 (24%). Lower adherence was significantly correlated with lower self-reported psychosocial QOL scores (p⫽.05) and lower self-reported treatment (barriers) scores (i.e. more perceived problems related to taking meds), r⫽.32, p⫽.006, including difficulty remembering to take meds (p⫽.03). Parental perceptions of the child’s QOL and treatment barrier scores however, were not significantly correlated with adherence. Adherence was not correlated with the child’s gender, SES, time since transplant, or number of meds taken. Patients with incomplete adherence tend to be older, p⫽.06. In a logistic regression analysis, only self-reported treatment barriers was a significant predictor of med adherence (p⫽.01).