体重指数变化对肾移植受者心血管结局的影响。

Effect of Changes in Body Mass Index on Cardiovascular Outcomes in Kidney Transplant Recipients.

作者信息

Kim K Y, Cho J-H, Jung H-Y, Choi J-Y, Park S-H, Kim C-D, Kim Y-L, Ro H, Lee S, Han S-Y, Jung C W, Park J B, Kim M S, Yang J, Ahn C

机构信息

Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.

出版信息

Transplant Proc. 2017 Jun;49(5):1038-1042. doi: 10.1016/j.transproceed.2017.03.049.

DOI:10.1016/j.transproceed.2017.03.049

PMID:28583522

Abstract

BACKGROUND

A higher body mass index (BMI) before kidney transplantation (KT) is associated with increased mortality and allograft loss in kidney transplant recipients (KTRs). However, the effect of changes in BMI after KT on these outcomes remains uncertain. The aim of this study was to investigate the effect of baseline BMI and changes in BMI on clinical outcomes in KTRs.

METHODS

A total of 869 KTRs were enrolled from a multicenter observational cohort study from 2012 to 2015. Patients were divided into low and high BMI groups before KT based on a BMI cutoff point of 23 kg/m. Differences in acute rejection and cardiovascular disease (CVD) between the 2 groups were analyzed. In addition, clinical outcomes across the 4 BMI groups divided by BMI change 1 year after KT were compared. Associations between BMI change and laboratory findings were also evaluated.

RESULTS

Patients with a higher BMI before KT showed significantly increased CVD after KT (P = .027) compared with patients with a lower BMI. However, among the KTRs with a higher baseline BMI, only persistently higher BMI was associated with increased CVD during the follow-up period (P = .003). Patients with persistently higher BMI had significantly decreased high-density lipoprotein cholesterol and increased hemoglobin, triglyceride, and hemoglobin A1c levels. Baseline BMI and post-transplantation change in BMI were not related to acute rejection in KTRs.

CONCLUSIONS

BMI in the 1st year after KT as well as baseline BMI were associated with CVD in KTRs. More careful monitoring of obese KTRs who do not undergo a reduction in BMI after KT is required.

摘要

背景

肾移植（KT）前较高的体重指数（BMI）与肾移植受者（KTRs）死亡率增加和移植肾丢失相关。然而，KT后BMI变化对这些结局的影响仍不确定。本研究旨在探讨基线BMI及BMI变化对KTRs临床结局的影响。

方法

从2012年至2015年的一项多中心观察性队列研究中纳入了869例KTRs。根据BMI临界值23kg/m²将患者在KT前分为低BMI组和高BMI组。分析两组间急性排斥反应和心血管疾病（CVD）的差异。此外，比较了根据KT后1年BMI变化划分的4个BMI组的临床结局。还评估了BMI变化与实验室检查结果之间的关联。

结果

与低BMI患者相比，KT前BMI较高的患者在KT后CVD显著增加（P = .027）。然而，在基线BMI较高的KTRs中，仅持续较高的BMI与随访期间CVD增加相关（P = .003）。BMI持续较高的患者高密度脂蛋白胆固醇显著降低，血红蛋白、甘油三酯和糖化血红蛋白水平升高。基线BMI和移植后BMI变化与KTRs的急性排斥反应无关。