Bédat Benoît, Niclauss Nadja, Jannot Anne-Sophie, Andres Axel, Toso Christian, Morel Philippe, Berney Thierry
1 Division of Visceral and Transplantation Surgery, Department of Surgery, University of Geneva Hospitals and School of Medicine, Genève, Switzerland. 2 Division of Clinical Epidemiology, University of Geneva Hospitals and School of Medicine, Genève, Switzerland.
Transplantation. 2015 Jan;99(1):94-9. doi: 10.1097/TP.0000000000000226.
The impact of recipient body mass index on graft and patient survival after pancreas transplantation is not well known.
We have analyzed data from all pancreas transplant recipients reported in the Scientific Registry of Transplant Recipients between 1987 and 2011. Recipients were categorized into BMI classes, as defined by the World Health Organization. Short-term (90 days) and long-term (90 days to 5 years) patient and graft survivals were analyzed according to recipient BMI class using Kaplan-Meier estimates. Hazard ratios were estimated using Cox proportional hazard models.
A total of 21,075 adult recipients were included in the analysis. Mean follow-up was 5 ± 1.1 years. Subjects were overweight or obese in 39%. Increasing recipient BMI was an independent predictor of pancreatic graft loss and patient death in the short term (P<0.001), especially for obese class II patient survival (hazard ratio, 2.07; P=0.009). In the long term, obesity, but not overweight, was associated with higher risk of graft failure (P=0.01). Underweight was associated with a higher risk of long-term death (P<0.001).
These results question the safety of pancreas transplantation in obese patients and suggest that they may be directed to alternate therapies, such as behavioral modifications or bariatric surgery, before pancreas transplantation is considered.
受体体重指数对胰腺移植后移植物和患者生存的影响尚不清楚。
我们分析了1987年至2011年间移植受者科学注册中心报告的所有胰腺移植受者的数据。根据世界卫生组织的定义，将受者分为不同的体重指数类别。使用Kaplan-Meier估计法，根据受体体重指数类别分析短期（90天）和长期（90天至5年）患者及移植物存活率。使用Cox比例风险模型估计风险比。
共有21,075名成年受者纳入分析。平均随访时间为5±1.1年。39%的受试者超重或肥胖。受体体重指数增加是短期胰腺移植物丢失和患者死亡的独立预测因素（P<0.001），尤其是对于II类肥胖患者的生存（风险比，2.07；P=0.009）。从长期来看，肥胖而非超重与移植物失败风险较高相关（P=0.01）。体重过轻与长期死亡风险较高相关（P<0.001）。
这些结果对肥胖患者胰腺移植的安全性提出质疑，并表明在考虑胰腺移植之前，可能应指导他们采用替代疗法，如行为改变或减重手术。
