Rogers J, Stratta R J, Lo A, Alloway R R
Medical University of South Carolina, Charleston, SC, USA.
Transplant Proc. 2005 Oct;37(8):3549-51. doi: 10.1016/j.transproceed.2005.09.021.
The metabolic syndrome (MS) has been implicated as an important nonimmunologic risk factor for chronic renal transplant dysfunction. The aim of this study was to determine the impact of the MS on outcomes in simultaneous kidney-pancreas transplantation (SKPT). Data were available on 241 patients enrolled in a prospective, multicenter randomized study of daclizumab compared with no antibody induction in SKPT. Presence of MS before and after SKPT was defined using NCEP-ATP III (National Cholesterol Education Program Adult Treatment Panel III) criteria. Body mass index (BMI) was used as a surrogate for waist circumference. MS was present in 59% of patients pretransplantation but only in 19% of patients 1 year after SKPT (P < .0001). Demographic and transplant characteristics were well matched for those with MS (MS+) and without MS (MS-) at 1 year. Presence of MS at 1 year was associated with the following changes at 3 years: increased serum creatinine level (1.65 mg/dL MS- vs 2.05 mg/dL MS+; P = .13); decreased modification of diet in renal disease calculated glomerular filtration rate (GFR; 58 mL/min MS- vs 48 mL/min MS+; P = .02); increased HgbA1C level (5.6% MS- vs 6.6% MS+; P < .001); and lower pancreas graft (PG) survival rate (88% MS- vs 71% MS+; P = .01). Linear regression analysis identified MS+ and the subgroup of MS+ without functioning PG at 1 year as independent risk factors for renal dysfunction, whereas MS+ with functioning PG at 1 year was not a risk factor for renal dysfunction. Presence of MS at 1 year is associated with long-term renal dysfunction after SKPT. Efforts to decrease early PG failure may help mitigate against MS-associated renal dysfunction.
代谢综合征（MS）被认为是慢性肾移植功能障碍的一个重要非免疫危险因素。本研究的目的是确定MS对同期肾胰联合移植（SKPT）结局的影响。数据来自一项前瞻性、多中心随机研究，该研究比较了达利珠单抗与SKPT中不进行抗体诱导的情况，共有241例患者参与。根据美国国家胆固醇教育计划成人治疗小组第三次报告（NCEP-ATP III）标准定义SKPT前后MS的存在情况。体重指数（BMI）用作腰围的替代指标。移植前59%的患者存在MS，但SKPT术后1年只有19%的患者存在MS（P <.0001）。1年后，MS患者（MS+）和无MS患者（MS-）的人口统计学和移植特征匹配良好。1年时存在MS与3年时以下变化相关：血清肌酐水平升高（MS-为1.65mg/dL，MS+为2.05mg/dL；P = 0.13）；计算的肾病饮食改良肾小球滤过率（GFR）降低（MS-为58mL/min，MS+为48mL/min；P = 0.02）；糖化血红蛋白（HgbA1C）水平升高（MS-为5.6%，MS+为6.6%；P <.001）；胰腺移植（PG）存活率降低（MS-为88%，MS+为71%；P = 0.01）。线性回归分析确定MS+以及1年时无功能PG的MS+亚组为肾功能障碍的独立危险因素，而1年时有功能PG的MS+不是肾功能障碍的危险因素。1年时存在MS与SKPT术后长期肾功能障碍相关。降低早期PG失败的努力可能有助于减轻与MS相关的肾功能障碍。
