Lietz K, John R, Burke E A, Ankersmit J H, McCue J D, Naka Y, Oz M C, Mancini D M, Edwards N M
Division of Cardiothoracic Surgery, Columbia Presbyterian Medical Center, Columbia University, New York, NY 10032, USA.
Transplantation. 2001 Jul 27;72(2):277-83. doi: 10.1097/00007890-200107270-00020.
Extremes in body weight are a relative contraindication to cardiac transplantation.
We retrospectively reviewed 474 consecutive adult patients (377 male, 97 female, mean age 50.3+/-12.2 years), who received 444 primary and 30 heart retransplants between January of 1992 and January of 1999. Of these, 68 cachectic (body mass index [BMI]<20 kg/m2), 113 overweight (BMI=>27-30 kg/m2), and 55 morbidly obese (BMI>30 kg/m2) patients were compared with 238 normal-weight recipients (BMI=20-27 kg/m2). We evaluated the influence of pretransplant BMI on morbidity and mortality after cardiac transplantation. Kaplan-Meier survival distribution and Cox proportional hazards model were used for statistical analyses.
Morbidly obese as well as cachectic recipients demonstrated nearly twice the 5-year mortality of normal-weight or overweight recipients (53% vs. 27%, respectively, P=0.001). An increase in mortality was seen at 30 days for morbidly obese and cachectic recipients (12.7% and 17.7%, respectively) versus a 30-day mortality rate of 7.6% in normal-weight recipients. Morbidly obese recipients experienced a shorter time to high-grade acute rejection (P=0.004) as well as an increased annual high-grade rejection frequency when compared with normal-weight recipients (P=0.001). By multivariable analysis, the incidence of transplant-related coronary artery disease (TCAD) was not increased in morbidly obese patients but cachectic patients had a significantly lower incidence of TCAD (P=0.05). Cachectic patients receiving oversized donor hearts had a significantly higher postoperative mortality (P=0.02).
The risks of cardiac transplantation are increased in both morbidly obese and cachectic patients compared with normal-weight recipients. However, the results of cardiac transplantation in overweight patients is comparable to that in normal-weight patients. Recipient size should be kept in mind while selecting patients and the use of oversized donors in cachectic recipients should be avoided.
体重 extremes 是心脏移植的相对禁忌证。
我们回顾性分析了 1992 年 1 月至 1999 年 1 月期间连续接受心脏移植的 474 例成年患者（男性 377 例，女性 97 例，平均年龄 50.3±12.2 岁），共进行了 444 例初次心脏移植和 30 例心脏再次移植。其中，将 68 例恶病质患者（体重指数[BMI]<20 kg/m²）、113 例超重患者（BMI=27-30 kg/m²）和 55 例病态肥胖患者（BMI>30 kg/m²）与 238 例体重正常的受者（BMI=20-27 kg/m²）进行比较。我们评估了移植前 BMI 对心脏移植后发病率和死亡率的影响。采用 Kaplan-Meier 生存分布和 Cox 比例风险模型进行统计分析。
病态肥胖患者和恶病质患者的 5 年死亡率几乎是体重正常或超重患者的两倍（分别为 53%和 27%，P=0.001）。病态肥胖患者和恶病质患者在术后 30 天的死亡率有所增加（分别为 12.7%和 17.7%），而体重正常患者的 30 天死亡率为 7.6%。与体重正常的受者相比，病态肥胖受者发生高级别急性排斥反应的时间更短（P=0.004），且每年高级别排斥反应的发生率更高（P=0.001）。通过多变量分析，病态肥胖患者移植相关冠状动脉疾病（TCAD）的发生率并未增加，但恶病质患者 TCAD 的发生率显著较低（P=0.05）。接受超大供心的恶病质患者术后死亡率显著更高（P=0.02）。
与体重正常的受者相比，病态肥胖患者和恶病质患者进行心脏移植的风险均增加。然而，超重患者心脏移植的结果与体重正常患者相当。在选择患者时应考虑受者体型，应避免给恶病质受者使用超大供心。
