肾移植候选者和接受者中的减肥手术：美国肾脏数据系统分析及文献综述
Bariatric surgery among kidney transplant candidates and recipients: analysis of the United States renal data system and literature review.
作者信息
Modanlou Kian A, Muthyala Umadevi, Xiao Huiling, Schnitzler Mark A, Salvalaggio Paolo R, Brennan Daniel C, Abbott Kevin C, Graff Ralph J, Lentine Krista L
机构信息
Division of Abdominal Organ Transplantation, Department of Surgery, Saint Louis University Medical Center, St. Louis, MO 63130, USA.
出版信息
Transplantation. 2009 Apr 27;87(8):1167-73. doi: 10.1097/TP.0b013e31819e3f14.
BACKGROUND
Limited data exist on the safety and efficacy of bariatric surgery (BS) in patients with kidney failure.
METHODS
We examined Medicare billing claims within USRDS registry data (1991-2004) to identify BS cases among renal allograft candidates and recipients.
RESULTS
Of 188 BS cases, 72 were performed pre-listing, 29 on the waitlist, and 87 post-transplant. Roux-en-Y gastric bypass was the most common procedure. Thirty-day mortality after BS performed on the waitlist and post-transplant was 3.5%, and one transplant recipient lost their graft within 30 days after BS. BMI data were available for a subset and suggested median excess body weight loss of 31%-61%. Comparison to published clinical trials of BS in populations without kidney disease indicates comparable weight loss but higher post-BS mortality in the USRDS sample.
CONCLUSIONS
Given the substantial contributions of obesity to excess morbidity and mortality, BS warrants prospective study as a strategy for improving outcomes before and after kidney transplantation.
背景
关于减肥手术（BS）在肾衰竭患者中的安全性和有效性的数据有限。
方法
我们在美国肾脏数据系统（USRDS）登记数据（1991 - 2004年）中检查了医疗保险计费索赔，以识别肾移植候选者和接受者中的减肥手术病例。
结果
在188例减肥手术病例中，72例在列入名单前进行，29例在等待名单上进行，87例在移植后进行。Roux - en - Y胃旁路术是最常见的手术方式。在等待名单上和移植后进行减肥手术后30天死亡率为3.5%，一名移植受者在减肥手术后30天内失去了移植肾。部分患者有体重指数（BMI）数据，提示多余体重减轻中位数为31% - 61%。与已发表的无肾脏疾病人群减肥手术临床试验相比，USRDS样本中的体重减轻情况相当，但减肥手术后死亡率更高。
结论
鉴于肥胖对额外发病率和死亡率有重大影响，减肥手术作为一种改善肾移植前后结局的策略值得进行前瞻性研究。
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