Conzen Kendra D, Vachharajani Neeta, Collins Kelly M, Anderson Christopher D, Lin Yiing, Wellen Jason R, Shenoy Surendra, Lowell Jeffrey A, Doyle M B Majella, Chapman William C
Section of Abdominal Transplantation, Department of Surgery, School of Medicine, Washington University in St Louis, St Louis, MO, USA.
HPB (Oxford). 2015 Mar;17(3):251-7. doi: 10.1111/hpb.12340. Epub 2014 Oct 17.
The effects of obesity in liver transplantation remain controversial. Earlier institutional data demonstrated no significant difference in postoperative complications or 1-year mortality. This study was conducted to test the hypothesis that obesity alone has minimal effect on longterm graft and overall survival.
A retrospective, single-institution analysis of outcomes in patients submitted to primary adult orthotopic liver transplantation was conducted using data for the period from 1 January 2002 to 31 December 2012. Recipients were divided into six groups by pre-transplant body mass index (BMI), comprising those with BMIs of <18.0 kg/m(2) , 18.0-24.9 kg/m(2) , 25.0-29.9 kg/m(2) , 30.0-35.0 kg/m(2) , 35.1-40.0 kg/m(2) and >40 kg/m(2) , respectively. Pre- and post-transplant parameters were compared. A P-value of <0.05 was considered to indicate statistical significance. Independent predictors of patient and graft survival were determined using multivariate analysis.
A total of 785 patients met the study inclusion criteria. A BMI of >35 kg/m(2) was associated with non-alcoholic steatohepatitis (NASH) cirrhosis (P < 0.0001), higher Model for End-stage Liver Disease (MELD) score, and longer wait times for transplant (P = 0.002). There were no differences in operative time, intensive care unit or hospital length of stay, or perioperative complications. Graft and patient survival at intervals up to 3 years were similar between groups. Compared with non-obese recipients, recipients with a BMI of >40 kg/m(2) showed significantly reduced 5-year graft (49.0% versus 75.8%; P < 0.02) and patient (51.3% versus 78.8%; P < 0.01) survival.
Obesity increasingly impacts outcomes in liver transplantation. Although the present data are limited by the fact that they were sourced from a single institution, they suggest that morbid obesity adversely affects longterm outcomes despite providing similar short-term results. Further analysis is indicated to identify risk factors for poor outcomes in morbidly obese patients.
肥胖对肝移植的影响仍存在争议。早期机构数据显示术后并发症或1年死亡率无显著差异。本研究旨在验证肥胖本身对长期移植物和总体生存影响极小这一假设。
采用2002年1月1日至2012年12月31日期间的数据，对接受初次成人原位肝移植患者的结局进行回顾性单机构分析。根据移植前体重指数（BMI）将受者分为六组，分别为BMI<18.0kg/m²、18.0 - 24.9kg/m²、25.0 - 29.9kg/m²、30.0 - 35.0kg/m²、35.1 - 40.0kg/m²和>40kg/m²的患者。比较移植前后参数。P值<0.05被认为具有统计学意义。使用多变量分析确定患者和移植物生存的独立预测因素。
共有785例患者符合研究纳入标准。BMI>35kg/m²与非酒精性脂肪性肝炎（NASH）肝硬化相关（P<0.0001），终末期肝病模型（MELD）评分更高，移植等待时间更长（P = 0.002）。手术时间、重症监护病房或住院时间以及围手术期并发症方面无差异。各亚组间长达3年的移植物和患者生存率相似。与非肥胖受者相比，BMI>40kg/m²的受者5年移植物生存率（49.0%对75.8%；P<0.02）和患者生存率（51.3%对78.8%；P<0.01）显著降低。
肥胖对肝移植结局的影响日益增加。尽管目前的数据因来自单一机构而受到限制，但表明病态肥胖尽管提供了相似的短期结果，但对长期结局有不利影响。需要进一步分析以确定病态肥胖患者不良结局的危险因素。
