Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Ann Surg. 2010 Jan;251(1):144-52. doi: 10.1097/SLA.0b013e3181b5db3c.
To determine the relationship between body mass index (BMI) at the time of transplant and posttransplant survival and morbidity.
The recent International Society for Heart and Lung Transplantation listing criteria for heart transplantation stated that candidates should achieve a BMI <30 kg/m-or percent ideal body weight <140%-before listing for cardiac transplantation. However, data to support these recommendations are limited and often conflicting.
United Network of Organ Sharing provided de-identified patient-level data. Analysis included 19,593 orthotopic heart transplant recipients aged >or=18 years and transplanted January 1 1995-December 31 2005. Follow-up data were provided through February 8, 2008. Recipients were stratified by BMI at the time of transplantation: BMI <18.5 (underweight), 18.5 to 24.99 (normal weight), 25 to 29.99 (overweight), 30 to 34.99 (obesity class I), and >or=35 (obesity class II/III). The primary outcome measure was post-transplant survival.
Risk-adjusted median survival in the underweight, normal weight, overweight, obesity I, and obesity II/III groups was 8.31, 10.20, 10.03, 9.51, and 9.05 years, respectively. In multivariate Cox proportional hazards regression, BMI in the overweight (HR = 1.08, 0.99-1.17; P = 0.055) and obesity I (HR = 1.05, 0.99-1.12; P = 0.091) ranges were not associated with significantly diminished survival. However, BMI in the underweight (HR = 1.26, 1.11-1.43; P < 0.001) and obesity II/III (HR = 1.18, 1.01-1.38; P = 0.030) ranges were associated with diminished posttransplant survival.
Findings from this analysis do not suggest that obesity I (BMI of 30-34.99) is associated with significantly higher morbidity and mortality. However, underweight and obesity II/III recipients have significantly higher morbidity and mortality compared with other groups.
确定移植时体重指数（BMI）与移植后生存和发病率之间的关系。
最近国际心肺移植学会发布的心脏移植候选者标准规定，候选者在接受心脏移植登记前，应实现 BMI＜30kg/m2 或理想体重百分比＜140%。然而，支持这些建议的数据有限，且往往相互矛盾。
美国器官共享联合网络提供了去标识的患者水平数据。分析包括 19593 例年龄≥18 岁且于 1995 年 1 月 1 日至 2005 年 12 月 31 日期间接受原位心脏移植的患者。通过 2008 年 2 月 8 日提供了随访数据。根据移植时的 BMI 将患者分层：BMI＜18.5（体重不足）、18.5 至 24.99（正常体重）、25 至 29.99（超重）、30 至 34.99（肥胖 I 级）和≥35（肥胖 II/III 级）。主要观察指标为移植后生存。
体重不足、正常体重、超重、肥胖 I 级和肥胖 II/III 级组的风险调整后中位生存时间分别为 8.31、10.20、10.03、9.51 和 9.05 年。在多变量 Cox 比例风险回归中，超重（HR=1.08，0.99-1.17；P=0.055）和肥胖 I 级（HR=1.05，0.99-1.12；P=0.091）范围内的 BMI 与生存明显下降无关。然而，体重不足（HR=1.26，1.11-1.43；P＜0.001）和肥胖 II/III 级（HR=1.18，1.01-1.38；P=0.030）范围内的 BMI 与移植后生存下降有关。
本分析结果表明，肥胖 I 级（BMI 为 30-34.99）并不与更高的发病率和死亡率显著相关。然而，体重不足和肥胖 II/III 级的受者与其他组相比，发病率和死亡率显著更高。
