The Transplant Center, Robert Wood Johnson University Hospital, New Brunswick, New Jersey.
Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey.
J Ren Nutr. 2014 Jan;24(1):50-7. doi: 10.1053/j.jrn.2013.07.001. Epub 2013 Sep 23.
Obesity is often an absolute contraindication to kidney transplant, but an internal analysis of our center's recipients suggests that not all obese populations exhibit poor outcomes. We used national data to compare outcomes in select groups of morbidly obese and normal-weight recipients after kidney transplant.
This study was a retrospective analysis of the Organ Procurement and Transplant Network/United Network for Organ Sharing database.
The study sample consisted of 30,132 morbidly obese (body mass index [BMI] 35-40 kg/m(2)) and normal-weight (BMI 18.5-24.9 kg/m(2)) patients who underwent primary kidney-only transplantation between 2001 and 2006.
Crude 3-year graft and patient survival rates of morbidly obese and normal-weight subgroups were evaluated. Logistic regression modeling compared 3-year graft failure and patient mortality in morbidly obese and normal-weight subgroups with opposite characteristics. Kaplan-Meier survival curves were created for 3-year graft and patient survival. Cox proportional hazard regression modeling was used to determine hazards for patient and graft mortality.
No differences in crude graft and patient survival rates were seen between normal weight and morbidly obese recipients who were African American, diabetic, and 50 to 80 years of age. Morbidly obese recipients who were nondialysis dependent, nondiabetic, had good functional status, and received living-donor transplants had significantly lower 3-year graft failure and patient mortality risk compared with normal-weight recipients who were dialysis dependent, diabetic, had poor functional status, and received a deceased-donor transplant, respectively (P < .01). Morbidly obese recipients have significantly lower graft and patient survival curves compared with normal-weight recipients; however, multivariate regression analysis reveals that morbid obesity is not an independent predictor of graft failure or patient mortality.
Morbid obesity is not independently associated with graft failure or patient mortality; therefore, it should not be used as a contraindication to kidney transplantation.
肥胖通常是肾移植的绝对禁忌证，但我们中心的受者内部分析表明，并非所有肥胖人群都表现出不良结局。我们使用国家数据比较了选择的病态肥胖和正常体重受者在肾移植后的结果。
这是一项对器官获取和移植网络/联合器官共享网络数据库的回顾性分析。
研究样本包括 30132 例病态肥胖（体重指数[BMI]35-40kg/m2）和正常体重（BMI 18.5-24.9kg/m2）的患者，他们在 2001 年至 2006 年间接受了单纯肾移植。
评估病态肥胖和正常体重亚组的原始 3 年移植物和患者生存率。Logistic 回归模型比较了病态肥胖和正常体重亚组中相反特征的 3 年移植物失败和患者死亡率。绘制 3 年移植物和患者生存率的 Kaplan-Meier 生存曲线。Cox 比例风险回归模型用于确定患者和移植物死亡率的危险。
在非裔美国人、糖尿病患者和 50 至 80 岁的患者中，正常体重和病态肥胖受者之间的原始移植物和患者生存率没有差异。与依赖透析、糖尿病、功能状态差、接受尸肾移植的正常体重受者相比，非依赖透析、非糖尿病、功能状态良好、接受活体供者移植的病态肥胖受者的 3 年移植物失败和患者死亡率风险显著降低（P<0.01）。病态肥胖受者的移植物和患者生存率曲线明显低于正常体重受者；然而，多变量回归分析显示病态肥胖不是移植物失败或患者死亡的独立预测因子。
病态肥胖与移植物失败或患者死亡无关；因此，不应该作为肾移植的禁忌证。
