# The impact of body composition on peri-operative and patient-centered outcomes in lung transplantation.

> **NIH NIH U01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2024 · $418,546

## Abstract

PROJECT ABSTRACT
Lung transplantation aims to extend survival, relieve disability, and improve health-related quality of life (HRQL).
Although many do well, perioperative complications have increased, one third of patients die within the first three
post-transplant years and 20-40% of survivors do not report improvements in patient-reported outcomes (PROs)
such as functioning and HRQL. Reasons for this lack of improvement are generally unknown. As a result, RFA-
022-002 highlights body composition and PROs as key priority areas for further investigation and intervention.
In earlier work using BMI, CT scans, and DXA, our group showed that obesity and sarcopenia are prevalent in lung
transplant candidates and are risk factors for frailty, primary graft dysfunction (PGD), and mortality. We also
highlighted, the challenges to more widely implementing these modalities and introduced bioelectrical impedance
(BIA) as a method of advanced body composition quantification that overcomes these challenges. We
demonstrated that obesity and sarcopenia by BIA are risk factors for PGD, and wait-list death. Our preliminary
data suggests that sarcopenic obesity may be a novel phenotype at heightened risk for perioperative
complications. After transplant, PGD and other perioperative complications contribute to disability, poor HRQL,
and death after transplant. Despite the clinical primacy of PROs, the only empirical data on the impact of
perioperative complications on PROs comes from our single-center work. Data on which PROs are responsive to
perioperative complications is lacking, hindering informed selection of PROs for use in future research. Finally,
defining the factors and events from before through early after transplant that impact PROs can identify and
prioritize targets for intervention and improve clinical trial efficiency through prognostic enrichment. To address
these problems, we will enroll 803 lung transplant candidates and, in Aim 1, will define the impact of sarcopenic
obesity, sarcopenia, and adiposity on peri-operative and PROs at 6-months. We hypothesize that sarcopenic
obesity will confer heightened risk for perioperative complications, including PGD, even in patients with normal
BMI. In Aim 2, we will define the responsiveness of PRO measures to PGD and other perioperative
complications. Aim 2 will provide the foundational empirical data needed to inform appropriate PRO selection for
future observational and interventional studies. Aim 3, will develop landmark prediction models accounting for
pre-, peri- and early post-operative factors to identify groups with worse post-operative PROs at 6-months and time
to graft failure up to 3-years after transplant. Developing new modeling of peri- and early post-operative outcomes
to predict which individuals are at risk for poor outcomes will inform the prognostic enrichment strategies needed
to improve clinical trial efficiency in lung transplant. In sum, we address key priorities in RFA HL-22-022 by...

## Key facts

- **NIH application ID:** 10899478
- **Project number:** 5U01HL163242-03
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Jonathan Paul Singer
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $418,546
- **Award type:** 5
- **Project period:** 2022-08-05 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10899478

## Citation

> US National Institutes of Health, RePORTER application 10899478, The impact of body composition on peri-operative and patient-centered outcomes in lung transplantation. (5U01HL163242-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10899478. Licensed CC0.

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