Werneck M, Afonso R C, Coelho G R, Sboarini C, Coelho M P V, Thomé T, Lisboa L F, Ferraz Neto B H
Programa Integrado de Transplante, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Transplant Proc. 2011 Jan-Feb;43(1):165-9. doi: 10.1016/j.transproceed.2010.12.004.
Obesity is a risk factor for patients undergoing major surgery. In liver transplantation, the morbidity and mortality in these patients may be higher owing to concomitant diseases that may prolong hospital stay. Moreover, the restrictive respiratory pattern in these patients, associated with pulmonary complications related to liver disease can impact the postoperative recovery. We sought to analyze the impact of high body mass index (BMI) on hospital and intensive care unit (ICU) stay, necessity and length of use either invasive and noninvasive ventilatory support in the early postoperative period after liver transplantation.
Between January 2007 and March 2009, we performed 85 liver transplantations in adult patients. BMI was calculated on the day of the transplantation. Data from 136 recipients undergoing OLT were reviewed by age, gender, etiology of liver disease, Model for End-Stage Liver Disease score, Child-Pugh class, cold and warm ischemic times, ICU stay, duration of invasive mechanical, and use of noninvasive ventilation (NIV). We divided the patients into 3 groups: Group 1, (normal weight BMI 18.5-24.99), versus group 2 overweight--BMI 25-29.99; versus group 3, obese--BMI ≥30.
Groups 1, 2, and 3 had similar lengths of stay in the ICU, necessity of NIV as well as 6 month, 1- and 2-year survivals (P > .05).
High BMI patients showed similar results to normal or overweight patients. Obesity should not be contraindication to liver transplantation.
肥胖是接受大手术患者的一个风险因素。在肝移植中，这些患者的发病率和死亡率可能更高，因为伴随疾病可能会延长住院时间。此外，这些患者的限制性呼吸模式，与肝病相关的肺部并发症有关，会影响术后恢复。我们试图分析高体重指数（BMI）对肝移植术后早期住院时间、重症监护病房（ICU）住院时间、有创和无创通气支持使用的必要性及时长的影响。
在2007年1月至2009年3月期间，我们对成年患者进行了85例肝移植手术。在移植当天计算BMI。对136例接受原位肝移植（OLT）的受者的数据，按年龄、性别、肝病病因、终末期肝病模型评分、Child-Pugh分级、冷缺血和热缺血时间、ICU住院时间、有创机械通气时长以及无创通气（NIV）的使用情况进行了回顾。我们将患者分为3组：第1组（正常体重，BMI 18.5 - 24.99），第2组超重（BMI 25 - 29.99），第3组肥胖（BMI≥30）。
第1、2和3组在ICU的住院时长、NIV的必要性以及6个月、1年和2年生存率方面相似（P > 0.05）。
高BMI患者的结果与正常或超重患者相似。肥胖不应成为肝移植的禁忌证。
