Clinical Implications of Metabolic Risk Factors in Lung Transplant Recipients
Bibliographic record
Abstract
RATIONALE: Metabolic risk factors (RF) have been associated with cardiovascular morbidity and poor graft survival in kidney and liver transplant recipients but have not been wellstudied in lung transplantation (LTx). We aimed to evaluate the prevalence of metabolic RF pre-and post-LTx, and test our hypothesis that pre-transplant metabolic RF are associated with an increased risk of chronic lung allograft dysfunction (CLAD) with detrimental effects on exercise capacity and post-LTx survival. METHODS: Single center, retrospective cohort study of LTx recipients listed 2014-2015 in the Toronto Lung Transplant Program. Clinical characteristics and pre-and post-LTx metabolic RF (hypertension, hyperlipidemia, diabetes, and obesity with BMI 30 kg/m 2 ) were abstracted from medical records. Subjects were categorized by number of pre-LTx metabolic RF present: 0; 1-2; and 3-4. Post-LTx six-minute walk distance (6MWD), CLAD and mortality within three-years post-transplant were compared across groups using one-way ANOVA and multivariable regression adjusting for age, sex, and diagnosis. RESULTS: 227 LTx recipients [median age 58 years, 60% males, BMI: 24.9 5.1 kg/m 2 , and 54% with interstitial lung disease (ILD)] were studied. Pre-LTx RF prevalence was: hypertension in 63 patients (28%), hyperlipidemia in 79 (35%), diabetes in 40 (18%) and obesity in 44 (19%). 43% of LTx recipients had no RF, 46% had 1-2 and 11% had 3-4 at time of transplant. The prevalence of 3-4 RF post-LTx was 26% at one and 34% at three-years, with obesity rates increasing to 31% by three-years. LTx recipients with 3-4 RF were more likely to have ILD (69%) as primary diagnosis compared to the other two RF groups (ILD 52%, p=0.01), but no differences were observed with respect to age, sex or pre-LTx 6MWD (cohort 304 m 108). Based on pre-LTx risk groups, there were significant differences in 6MWD improvement across groups in the first two-years post-transplant (Figure), which remained significant after adjustment for age, sex, and diagnosis. By three-years post-LTx, incidence of CLAD was 55/227 (24%) and all-cause mortality was 64/227 (28%), but no independent differences were observed between risk groups with respect to CLAD [3-4 vs. 1-2 RF; HR: 1.67 95% CI (0.8 -3.7), p=0.13] or all-cause mortality [HR: 1.74 95% (0.9 -3.4), p=0.14]. CONCLUSION: Metabolic RF were prevalent pre-and post-LTx, and were associated with lower exercise capacity post-LTx, but not CLAD or survival. Future studies exploring lifestyle interventions aimed at improving pre-and post-LTx metabolic RF and functional capacity are needed.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".