Gusukuma L W, Harada K M, Baptista A P M, Alencar M R P, de Sandes-Freitas T V, Tedesco-Silva H, Medina-Pestana J O
Nephrology Division, Hospital do Rim e Hipertensão, Universidade Federal de São Paulo, São Paulo, Brazil.
Nephrology Division, Hospital do Rim e Hipertensão, Universidade Federal de São Paulo, São Paulo, Brazil.
Transplant Proc. 2014 Dec;46(10):3416-9. doi: 10.1016/j.transproceed.2014.09.112.
Kidney transplantation (KT) in obese patients is controversial. The present study aimed to evaluate patient and graft survival and post-transplantation complications between obese and nonobese recipients.
Patients (n = 3,054) receiving a KT from 1998 to 2008 were divided according to body mass index (BMI) into 3 groups for analysis: group I: BMI <30 kg/m(2) (nonobese); group II: ≥30-34.9 kg/m(2) (class I obese); and group III: ≥35 kg/m(2) (class II and III obese).
Mean BMIs were: group I (n = 2,822): 22.6 ± 3.3 kg/m(2); group II (n = 185): 31.9 ± 1.3 kg/m(2); and group III (n = 47): 36.8 ± 1.7 kg/m(2). There were no differences among the 3 groups in patient demographic variables regarding race, sex, or organ source. One-year (I, 98%; II, 98%; III, 95%) and 5-year (I, 90%; II, 92%; III, 89%) patient survival rates were similar among groups. Graft survival rates at 1 year were 96% for groups I and II and 91.5% for group III. Five-year graft survivals were: I, 81%; II, 96%; and III, 79%. The most common cause of graft loss was death, and the main cause of death was infection in all groups. Obese patients were more likely to experience wound dehiscence (I, 1.9%; II, 7.6%; III, 19.1%; P < .001), develop new-onset diabetes after transplantation (NODAT; I, 16.2%; II, 27%; III, 36%; P < .001), and have a prolonged length of hospital stay (I, 11.3 ± 11.4 d; II, 14.5 ± 14.3 d; III, 15.9 ± 16.7 d; P < .001).
Obese recipients demonstrated outcomes similar to nonobese patients regarding patient and graft survival. However, they had higher rates of prolonged length of hospital stay, wound dehiscence, and NODAT.
肥胖患者的肾移植存在争议。本研究旨在评估肥胖和非肥胖受者的患者及移植物存活率以及移植后并发症。
将1998年至2008年接受肾移植的3054例患者根据体重指数（BMI）分为3组进行分析：第一组：BMI<30kg/m²（非肥胖）；第二组：≥30 - 34.9kg/m²（I级肥胖）；第三组：≥35kg/m²（II级和III级肥胖）。
平均BMI分别为：第一组（n = 2822）：22.6±3.3kg/m²；第二组（n = 185）：31.9±1.3kg/m²；第三组（n = 47）：36.8±1.7kg/m²。三组患者在种族、性别或器官来源等人口统计学变量方面无差异。三组的1年（第一组，98%；第二组，98%；第三组，95%）和5年（第一组，90%；第二组，92%；第三组，89%）患者存活率相似。第一组和第二组的1年移植物存活率为96%，第三组为91.5%。5年移植物存活率分别为：第一组，81%；第二组，96%；第三组，79%。移植物丢失的最常见原因是死亡，所有组的主要死亡原因是感染。肥胖患者更易发生伤口裂开（第一组，1.9%；第二组，7.6%；第三组，19.1%；P<.001）、移植后新发糖尿病（NODAT；第一组，16.2%；第二组，27%；第三组，36%；P<.001）以及住院时间延长（第一组，11.3±11.4天；第二组，14.5±14.3天；第三组，15.9±16.7天；P<.001）。
肥胖受者在患者及移植物存活率方面的结果与非肥胖患者相似。然而，他们的住院时间延长、伤口裂开和NODAT发生率较高。
