Center for Outcomes Research, Saint Louis University School of Medicine, St Louis, MO 63104, USA.
Am Heart J. 2009 Dec;158(6):972-82. doi: 10.1016/j.ahj.2009.10.009.
The relationship of body mass index (BMI) with heart failure (HF) risk before and after kidney transplant is not well described.
We examined United States Renal Data System records for 67,591 kidney transplant candidates (1995-2004) with Medicare insurance and BMI data at listing. Heart failure diagnoses were ascertained from Medicare billing claims. Body mass index was categorized per World Health Organization criteria. We modeled time-dependent associations (adjusted hazard ratio, aHR) of transplant with HF risk after listing compared with waiting in each BMI group by multivariable, stratified Cox regression. The time-dependent exposure variables partitioned relative risk of HF after transplant versus waiting into early (<or=90 days) and late (>90 days) posttransplant periods.
The BMI distribution of listed candidates was as follows: 3.7% under, 40.4% normal, 32.0% over, 16.2% obese, and 7.7% morbidly obese weight. The prevalence of HF among patients awaiting transplant reached 57.4% by 3 years. Deceased-donor transplant was associated with increased early HF risk compared with continued waiting-aHRs ranged from 2.23 for normal-BMI to 2.82 for morbidly obese patients. However, transplant reduced the risk of HF in the late posttransplant period from 54% (aHR 0.46) in normal-BMI to 32% (aHR 0.68) for morbidly obese patients. Relative benefits were largest for normal-weight candidates who received live-donor transplants (aHR 0.31).
Heart failure risk improves in obese patients in the long term after kidney transplant, but not as much as for nonobese patients. There is need for close monitoring and for new strategies to reduce HF risk in obese patients before and after transplant.
在接受肾移植前后，体重指数（BMI）与心力衰竭（HF）风险之间的关系尚未得到充分描述。
我们在美国肾脏数据系统中检查了 67591 名有医疗保险且在登记时具有 BMI 数据的肾移植候选人（1995-2004 年）的记录。心力衰竭诊断是通过医疗保险账单索赔确定的。根据世界卫生组织的标准，BMI 进行了分类。我们通过多变量分层 Cox 回归，为每个 BMI 组中列出后的移植与等待相比，建立了移植与 HF 风险的时间依赖性关联（调整后的危险比，aHR）。时间依赖性暴露变量将移植后与等待相比 HF 的相对风险分为早期（<=90 天）和晚期（>90 天）移植后时期。
列出的候选人的 BMI 分布如下：低于 3.7%，正常 40.4%，超重 32.0%，肥胖 16.2%，病态肥胖 7.7%。等待移植的患者 HF 的患病率在 3 年内达到 57.4%。与继续等待相比，供体死亡的移植与早期 HF 风险增加相关-aHR 范围从正常 BMI 的 2.23 到病态肥胖患者的 2.82。然而，移植降低了正常 BMI 患者的晚期移植后 HF 风险（aHR 0.46）至病态肥胖患者的 32%（aHR 0.68）。对于接受活体供体移植的正常体重候选人，相对益处最大（aHR 0.31）。
在接受肾移植后，肥胖患者的心力衰竭风险在长期内得到改善，但不如非肥胖患者明显。在移植前和移植后，需要密切监测并制定新策略来降低肥胖患者的 HF 风险。
