Barone M, Viggiani M T, Losurdo G, Principi M, Leandro G, Di Leo A
Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy.
Gastroenterology unit, I.R.C.C.S. "De Bellis", Castellana Grotte, Bari, Italy.
Aliment Pharmacol Ther. 2017 Aug;46(3):236-245. doi: 10.1111/apt.14139. Epub 2017 May 10.
International guidelines rate class III (morbid) obesity (body mass index [BMI]≥40 kg/m ) as a relative contraindication for liver transplantation (LT) requiring further research. Moreover, data on the mortality risk in candidates with a BMI: 30-34.9 and 35-39.9 kg/m (class I and class II obesity, respectively) are weak.
To compare post-operative complications and mortality risks in all obese candidates vs candidates with a BMI: 18.5-29.9 (normal/overweight) assumed as controls.
We searched the Cochrane library, PubMed, Scopus, Web-of-Science and article reference lists, restricted to the English language, and selected cohort studies analysing the following outcomes: all-causes mortality (at 30 days, 1-2-3-5 years), post-operative and cardiopulmonary complications, hospital and intensive care unit (ICU) length of stay. Two reviewers independently extracted the studies data and a third one resolved discrepancies.
Twenty-four studies comprising 132 162 patients met the inclusion criteria. As compared to controls, mortality risk was increased at all time-periods (except at 3 years) for a BMI≥40, at 30 days for a BMI: 30-34.9 and in none of the considered time-periods for a BMI: 35-39.9. Post-operative complications were significantly higher for a BMI>30 and 30-34.9. Due to the shortage/absence of data, we evaluated cardiopulmonary complications, hospital and ICU length of stay only in the BMI≥30 category. In these patients, only cardiopulmonary complications were increased as compared to controls.
Morbid obesity has an impact on patients' survival after LT. However, since even a BMI>30 increases post-transplant complications, new strategies should be included in the LT programme to favour weight loss in all obese candidates.
国际指南将Ⅲ级（病态）肥胖（体重指数[BMI]≥40kg/m²）列为肝移植（LT）的相对禁忌证，需要进一步研究。此外，关于BMI为30 - 34.9和35 - 39.9kg/m²（分别为Ⅰ级和Ⅱ级肥胖）的候选者死亡风险的数据较少。
比较所有肥胖候选者与BMI为18.5 - 29.9（正常/超重）的候选者（作为对照）术后并发症和死亡风险。
我们检索了Cochrane图书馆、PubMed、Scopus、科学网及文章参考文献列表，仅限于英文文献，并选择队列研究分析以下结果：全因死亡率（30天、1 - 2 - 3 - 5年）、术后及心肺并发症、住院时间和重症监护病房（ICU）住院时间。两名评审员独立提取研究数据，第三名评审员解决差异。
24项研究共纳入132162例患者，符合纳入标准。与对照组相比，BMI≥40者在所有时间段（3年除外）死亡风险增加，BMI为30 - 34.9者在30天死亡风险增加，BMI为35 - 39.9者在所有考虑的时间段死亡风险均未增加。BMI>30和30 - 34.9者术后并发症显著更高。由于数据短缺/缺乏，我们仅在BMI≥30组评估心肺并发症、住院时间和ICU住院时间。在这些患者中，与对照组相比仅心肺并发症增加。
病态肥胖对肝移植术后患者生存有影响。然而，由于即使BMI>30也会增加移植后并发症，肝移植项目应纳入新策略，以促进所有肥胖候选者减重。
