Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Am J Respir Crit Care Med. 2011 Nov 1;184(9):1055-61. doi: 10.1164/rccm.201104-0728OC.
Obesity has been linked to acute lung injury and is a risk factor for early mortality after lung transplantation.
To examine the associations of obesity and plasma adipokines with the risk of primary graft dysfunction after lung transplantation.
We performed a prospective cohort study of 512 adult lung transplant recipients with chronic obstructive pulmonary disease or interstitial lung disease enrolled in the Lung Transplant Outcomes Group Study. In a nested case-control study, we measured plasma leptin, adiponectin, and resistin before lung transplantation and 6 and 24 hours after lung transplantation in 40 cases of primary graft dysfunction and 80 control subjects. Generalized linear mixed models and logistic regression were used to estimate risk ratios and odds ratios.
Grade 3 primary graft dysfunction developed within 72 hours of transplantation in 29% participants. Obesity was associated with a twofold increased risk of primary graft dysfunction (adjusted risk ratio 2.1; 95% confidence interval, 1.7-2.6). The risk of primary graft dysfunction increased by 40% (confidence interval, 30–50%) for each 5 kg/m(2) increase in body mass index after accounting for center, diagnosis, cardiopulmonary bypass, and transplant procedure. Higher plasma leptin levels were associated with a greater risk of primary graft dysfunction (sex-adjusted P = 0.02). The associations of both obesity and leptin with primary graft dysfunction tended to be stronger among those who did not undergo cardiopulmonary bypass.
Obesity is an independent risk factor for primary graft dysfunction after lung transplantation.
肥胖与急性肺损伤有关，是肺移植后早期死亡的一个危险因素。
研究肥胖和血浆脂肪因子与肺移植后原发性移植物功能障碍的风险之间的相关性。
我们对慢性阻塞性肺疾病或间质性肺疾病的 512 例成人肺移植受者进行了前瞻性队列研究，这些受者参加了肺移植结局研究组。在巢式病例对照研究中，我们在肺移植后 6 小时和 24 小时测量了 40 例原发性移植物功能障碍患者和 80 例对照者的血浆瘦素、脂联素和抵抗素。使用广义线性混合模型和逻辑回归来估计风险比和比值比。
29%的患者在移植后 72 小时内出现 3 级原发性移植物功能障碍。肥胖使原发性移植物功能障碍的风险增加两倍（调整风险比 2.1；95%置信区间，1.7-2.6）。在考虑中心、诊断、体外循环和移植程序后，体重指数每增加 5kg/m²，原发性移植物功能障碍的风险增加 40%（置信区间，30-50%）。较高的血浆瘦素水平与原发性移植物功能障碍的风险增加相关（性别调整 P = 0.02）。肥胖和瘦素与原发性移植物功能障碍的相关性在未行体外循环的患者中似乎更强。
肥胖是肺移植后原发性移植物功能障碍的一个独立危险因素。
