移植前超重和肥胖不会影响肾移植后的身体生活质量。

Pre-transplant overweight and obesity do not affect physical quality of life after kidney transplantation.

机构信息

Department of Surgery and Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN 37232-2730, USA.

出版信息

J Am Coll Surg. 2010 Mar;210(3):336-44. doi: 10.1016/j.jamcollsurg.2009.11.009. Epub 2010 Feb 1.

DOI:10.1016/j.jamcollsurg.2009.11.009

PMID:20193898

Abstract

BACKGROUND

Recent studies demonstrate that obesity does not affect survival after kidney transplantation. However, overweight and obesity impair health-related quality of life (HRQOL) in patients with chronic illnesses. We wished to examine the effects of pre-transplant overweight and obesity on post-transplant physical HRQOL in kidney transplant recipients.

STUDY DESIGN

Patient-reported HRQOL data were systematically collected in kidney transplant recipients receiving post-transplant follow-up at Vanderbilt Transplant Center. Patients who received kidney transplants between 1998 and 2008, had at least 1 post-transplant physical component summary (PCS) measurement, and did not receive other solid organ transplants were included in this retrospective cohort study. Pre-transplant body mass index was stratified as normal, overweight, obese class I, and obese class II/extremely obese. HRQOL was measured primarily with the PCS scale of the Medical Outcomes Study Short Form 36 Health Survey. Multivariate linear and logistic regression models were used to test the effects of body mass index and demographic and clinical covariates on post-transplant HRQOL.

RESULTS

The study cohort included 464 adults (mean body mass index 27.5 +/- 5.1; range 18.5 to 47.4). After controlling for gender (p = 0.148), pre-transplant dialysis (p = 0.003), previous kidney transplantation (p = 0.255), donor type (p = 0.455), steroid avoidance immunosuppression (p = 0.070), and follow-up time (p = 0.352), there was no effect of pre-transplant overweight or obesity on post-transplant PCS (all p > or = 0.112). Kidney transplant recipients who did not require dialysis pre-transplant and those who were managed with steroid avoidance after transplantation were more likely to achieve post-transplant PCS scores at or above the general population average (both p < or = 0.011).

CONCLUSIONS

Pre-transplant overweight and obesity do not affect physical quality of life after kidney transplantation.

摘要

背景

最近的研究表明，肥胖并不影响肾移植后的存活率。然而，超重和肥胖会损害患有慢性疾病患者的健康相关生活质量（HRQOL）。我们希望研究移植前超重和肥胖对肾移植受者移植后身体 HRQOL 的影响。

研究设计

患者报告的 HRQOL 数据在范德比尔特移植中心接受移植后随访的肾移植受者中系统收集。这项回顾性队列研究纳入了 1998 年至 2008 年间接受肾移植、至少有一次移植后身体成分综合测量值且未接受其他实体器官移植的患者。移植前体重指数分为正常、超重、肥胖 I 级和肥胖 II/极度肥胖。HRQOL 主要用医疗结局研究 36 项简短健康调查的身体成分量表来衡量。使用多变量线性和逻辑回归模型来测试体重指数和人口统计学及临床协变量对移植后 HRQOL 的影响。

结果

研究队列包括 464 名成年人（平均体重指数 27.5±5.1；范围 18.5 至 47.4）。在控制性别（p=0.148）、移植前透析（p=0.003）、先前肾移植（p=0.255）、供体类型（p=0.455）、避免使用类固醇的免疫抑制（p=0.070）和随访时间（p=0.352）后，移植前超重或肥胖对移植后 PCS 没有影响（所有 p≥0.112）。移植前无需透析且移植后采用避免使用类固醇治疗的肾移植受者更有可能达到移植后 PCS 评分等于或高于一般人群平均值（两者 p≤0.011）。