Laurence Jerome M, Marquez Max A, Bazerbachi Fateh, Seal John B, Selzner Markus, Norgate Andrea, McGilvray Ian D, Schiff Jeffrey, Cattral Mark S
1 Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. 2 Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Transplantation. 2015 Jun;99(6):1282-7. doi: 10.1097/TP.0000000000000495.
Pancreas transplant recipient obesity has been associated with increased risk of perioperative complications, graft failure, and death. The imperative to maximize organ utility must be balanced against the need to maintain equity of access, including for the increasing number of obese diabetic patients.
We compared the outcomes of pancreas transplant recipients with body mass index (BMI) greater than 30 kg/m(2) (n=60, mean ± SD BMI 32.1 ± 1.7 kg/m(2)) to those with BMI less than 30 kg/m(2) (n=308, mean ± SD BMI 24.5 ± 2.7 kg/m(2)) between 1996 and 2013.
There were no differences in the pretransplant recipient or donor characteristics apart from BMI. The BMI greater than 30 group were more likely to suffer a rejection episode (43% vs. 29%; P = 0.03). The median time to first rejection was shorter (1 vs. 6 months; P = 0.04), and wound infection was more common in the BMI greater than 30 group (P = 0.03). There was no difference in the rate of patient, pancreas, or kidney graft survival or difference in graft function between the two groups.
The obese recipients in this study were in the lower range of the obese category. Although there was an increased risk of rejection and wound infection in the obese group, there was no difference in patient or graft survival. This finding, when compared with previous reports, may be related to stringent recipient selection and posttransplant care particularly with respect to cardiovascular disease.
胰腺移植受者肥胖与围手术期并发症、移植物失功及死亡风险增加相关。在努力实现器官效用最大化的同时，必须兼顾维持公平获取的需求，包括越来越多的肥胖糖尿病患者。
我们比较了1996年至2013年间体重指数（BMI）大于30kg/m²（n = 60，平均±标准差BMI 32.1±1.7kg/m²）的胰腺移植受者与BMI小于30kg/m²（n = 308，平均±标准差BMI 24.5±2.7kg/m²）的胰腺移植受者的结局。
除BMI外，移植前受者或供者特征无差异。BMI大于30的组更易发生排斥反应（43%对29%；P = 0.03）。首次排斥反应的中位时间更短（1个月对6个月；P = 0.04），且BMI大于30的组伤口感染更常见（P = 0.03）。两组的患者、胰腺或肾移植物存活率及移植物功能无差异。
本研究中的肥胖受者处于肥胖类别范围的下限。尽管肥胖组排斥反应和伤口感染风险增加，但患者或移植物存活率无差异。与既往报告相比，这一发现可能与严格的受者选择及移植后护理有关，尤其是在心血管疾病方面。
