肥胖与胰肾联合移植的不良结局相关。

Obesity was associated with inferior outcomes in simultaneous pancreas kidney transplant.

机构信息

Division of Nephrology, Kidney and Pancreas Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, CA USA.

出版信息

Transplantation. 2010 May 15;89(9):1117-25. doi: 10.1097/TP.0b013e3181d2bfb2.

DOI:10.1097/TP.0b013e3181d2bfb2

PMID:20164819

Abstract

BACKGROUND.: In kidney transplant, obesity was reported to be associated with increased posttransplant complications and worse survival outcomes. The impact of obesity in simultaneous pancreas-kidney (SPK) transplant is less known. METHODS.: Using Organ Procurement Transplantation Network/United Network for Organ Sharing data as of August 2008, we included all adults (>18 years) type 1 diabetic SPK recipients between years 2000 and 2007 with a pretransplant body mass index (BMI) of 18.5 to 40 kg/m. The cohort was divided in three groups: normal (BMI 18.5-24.9 kg/m, reference group), overweight (BMI 25-29.9 kg/m), and obese (BMI 30-40 kg/m). Covariate-adjusted relative risk of a combination of posttransplant complications and patient, pancreas and kidney allograft outcomes were evaluated. RESULTS.: Of 5725 recipients, 56%, 33%, and 11% were in normal, overweight, and obese groups, respectively. Overweight and obese recipients were older, had a higher percent of coronary artery disease, and private health insurance coverage. Overall posttransplant complications were higher in obese group (35.7% vs. 28.6%) when compared with normal BMI group. They were mainly due to increased delayed kidney graft function (11.8% vs. 7.4%), 1-year kidney acute rejection (17.0% vs. 12.1%), and pancreas graft thrombosis (2.6% vs. 1.3%). After adjusting for possible confounders, the odds ratios for overall transplant complications were 1.03 (95% confidence interval [CI]: 0.90-1.17) for overweight and 1.38 (95% CI: 1.15-1.68) for obese. Obesity, but not overweight, was associated with patient death (hazard ratio [HR]: 1.35; 95% CI: 1.00-1.81), pancreas graft loss (HR: 1.41; 95% CI: 1.17-1.69), and kidney graft loss (HR: 1.33; 95% CI: 1.05-1.67) at 3 years. The higher rates of death and graft failure in the first 30 days posttransplant mostly accounted for the 3-year survival differences. CONCLUSION.: Obesity in SPK recipients was associated with increased risk of posttransplant complications, pancreas and kidney graft loss, and patient death.

摘要

背景

在肾移植中，肥胖与移植后并发症增加和生存结果恶化有关。肥胖对同时胰腺-肾（SPK）移植的影响知之甚少。

方法

利用截至 2008 年 8 月的器官获取与移植网络/联合器官共享网络的数据，我们纳入了 2000 年至 2007 年间患有 1 型糖尿病的所有成人（>18 岁）SPK 受者，其移植前体质量指数（BMI）为 18.5 至 40kg/m²。该队列分为三组：正常（BMI 18.5-24.9kg/m²，参考组）、超重（BMI 25-29.9kg/m²）和肥胖（BMI 30-40kg/m²）。评估了移植后并发症以及患者、胰腺和肾脏移植物结局的综合风险比。

结果

在 5725 名受者中，分别有 56%、33%和 11%的人处于正常、超重和肥胖组。超重和肥胖组的受者年龄较大，患有冠状动脉疾病的比例较高，且拥有私人医疗保险。与正常 BMI 组相比，肥胖组的整体移植后并发症发生率更高（35.7%比 28.6%）。这些并发症主要是由于延迟的肾脏移植物功能障碍（11.8%比 7.4%）、1 年肾脏急性排斥反应（17.0%比 12.1%）和胰腺移植物血栓形成（2.6%比 1.3%）引起的。在校正了可能的混杂因素后，超重的整体移植并发症的优势比为 1.03（95%置信区间[CI]：0.90-1.17），肥胖的优势比为 1.38（95%CI：1.15-1.68）。肥胖但非超重与患者死亡（风险比[HR]：1.35；95%CI：1.00-1.81）、胰腺移植物丢失（HR：1.41；95%CI：1.17-1.69）和肾脏移植物丢失（HR：1.33；95%CI：1.05-1.67）相关。移植后 3 年内，移植后 30 天内死亡和移植物功能丧失的较高发生率主要导致了 3 年生存率的差异。