Liese Juliane, Bottner Nils, Büttner Stefan, Reinisch Alexander, Woeste Guido, Wortmann Markus, Hauser Ingeborg A, Bechstein Wolf Otto, Ulrich Frank
Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
Medical Clinic III, Department of Nephrology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
Langenbecks Arch Surg. 2018 Feb;403(1):73-82. doi: 10.1007/s00423-017-1584-7. Epub 2017 May 10.
The relationship between the body mass index (BMI) of kidney transplant recipients and outcomes after kidney transplantation (KT) is not fully understood and remains controversial. We studied the influence of BMI on clinically relevant outcomes in kidney transplant recipients.
In this retrospective single-centre study, all patients who underwent kidney transplantation at our institution between January 2007 and December 2012 were included. Demographic data and BMI were correlated with the clinical course of the disease, rejection rates, delayed graft function rates, and graft and patient survival.
During the study period, 384 single KTs (130 women and 254 men) were performed. Seventeen percent of the transplants were transplanted within the Eurotransplant Senior Programme (ESP). Most of the transplants were performed using organs that were obtained from donors after brain death (DBD), and living donor kidney transplants were performed in 22.4% of all transplants. The median BMI of the recipients was 25.9 kg/m. Additionally, 13.5% of the recipients had a BMI of 30-34.9 kg/m and 3.9% had a BMI >35 kg/m. A BMI >30 kg/m was significantly associated with primary non-function of the kidney (p = 0.047), delayed graft function (p = 0.008), and a higher rate of loss of graft function (p = 0.015). The glomerular filtration rate 12 months after KT was significantly lower in recipients with a BMI >30 kg/m. Multivariate analysis revealed that recipient BMI, among other factors, was an independent risk factor for delayed graft function and graft survival. Patients with a BMI >30 kg/m had an almost four times higher risk for surgical site infection than did recipients with a lower BMI.
Increased BMI at kidney transplantation is a predictor of adverse outcomes, including delayed graft function. These findings demonstrate the importance of the careful selection of patients and pre-transplant weight reduction, although the role of weight reduction for improving graft function is not clear.
肾移植受者的体重指数（BMI）与肾移植（KT）后的预后之间的关系尚未完全明确，仍存在争议。我们研究了BMI对肾移植受者临床相关预后的影响。
在这项回顾性单中心研究中，纳入了2007年1月至2012年12月期间在本机构接受肾移植的所有患者。人口统计学数据和BMI与疾病的临床进程、排斥率、移植肾功能延迟恢复率以及移植肾和患者的生存率相关。
在研究期间，共进行了384例单肾移植（130例女性和254例男性）。17%的移植在欧洲移植高级计划（ESP）内进行。大多数移植使用的是脑死亡后供体的器官，22.4%的移植为活体供肾移植。受者的中位BMI为25.9kg/m²。此外，13.5%的受者BMI为30 - 34.9kg/m²，3.9%的受者BMI>35kg/m²。BMI>30kg/m²与移植肾原发性无功能（p = 0.047）、移植肾功能延迟恢复（p = 0.008）以及移植肾功能丧失率较高（p = 0.015）显著相关。BMI>30kg/m²的受者在肾移植后12个月时的肾小球滤过率显著较低。多因素分析显示，除其他因素外，受者BMI是移植肾功能延迟恢复和移植肾存活的独立危险因素。BMI>30kg/m²的患者手术部位感染风险几乎是BMI较低受者的四倍。
肾移植时BMI升高是包括移植肾功能延迟恢复在内的不良预后的预测指标。这些发现表明了谨慎选择患者和移植前减轻体重的重要性，尽管减轻体重对改善移植肾功能的作用尚不清楚。
