Division of Nephrology, Kidney and Pancreas Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, CA USA.
Transplantation. 2010 May 15;89(9):1117-25. doi: 10.1097/TP.0b013e3181d2bfb2.
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.
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。
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。
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。
SPK 受者肥胖与移植后并发症、胰腺和肾脏移植物丢失以及患者死亡的风险增加有关。
