Dick André A S, Hansen Ryan N, Montenovo Martin I, Healey Patrick J, Smith Jodi M
Department of Surgery, Section of Pediatric Transplantation, Seattle Children's Hospital, Seattle, WA, USA.
Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, WA, USA.
Pediatr Transplant. 2017 Sep;21(6). doi: 10.1111/petr.12992. Epub 2017 Jun 13.
Controversies exist regarding the impact of obesity on patients undergoing kidney transplantation. We sought to estimate the association between BMI and patient outcomes (survival and graft function) among pediatric kidney transplant patients in the USA. We conducted a retrospective analysis of the United Network for Organ Sharing database (1987-2013), which revealed 13 014 pediatric patients (<18 years old) who underwent primary kidney transplantation. Patients were stratified into five BMI categories established by the World Health Organizations according to their Z score, which is based on age, gender and BMI. The -2, 0, and +2 categories were collapsed and served as the reference group, while the -3 (thin) and +3 (obese) categories were evaluated for differences in graft and patient survival. The survival rates between these categories were compared using the Kaplan-Meier estimator. Cox proportional hazards models were constructed to adjust for recipient and donor characteristics to estimate the risk of graft loss and mortality associated with BMI. Logistic regression models were estimated to evaluate whether there was an association between BMI and DGF. There were no differences in overall patient (P=.1655) or graft (P=.1688) survival between the severely thin, normal, and obese patients. Adjusted models also revealed no statistically significant differences in graft or patient survival. There were no differences in the odds of DGF (both unadjusted and adjusted) among the three groups. The prevalence of obesity is increasing among children who present for kidney transplant in the USA. In this national study of pediatric kidney transplant recipients, there was no difference in graft or patient survival and no differences in rates of DGF among obese children compared to normal and underweight children undergoing kidney transplantation.
肥胖对接受肾移植患者的影响存在争议。我们试图评估美国小儿肾移植患者体重指数（BMI）与患者预后（生存和移植肾功能）之间的关联。我们对器官共享联合网络数据库（1987 - 2013年）进行了回顾性分析，该数据库显示有13014例年龄小于18岁的小儿患者接受了初次肾移植。根据世界卫生组织依据年龄、性别和BMI建立的Z评分，将患者分为五个BMI类别。-2、0和 +2类别合并作为参照组，而 -3（消瘦）和 +3（肥胖）类别则评估移植和患者生存情况的差异。使用Kaplan - Meier估计量比较这些类别之间的生存率。构建Cox比例风险模型以调整受者和供者特征，以评估与BMI相关的移植丢失和死亡风险。估计逻辑回归模型以评估BMI与移植肾功能延迟恢复（DGF）之间是否存在关联。严重消瘦、正常和肥胖患者之间的总体患者生存率（P = 0.1655）或移植生存率（P = 0.1688）没有差异。调整后的模型也显示移植或患者生存率没有统计学上的显著差异。三组之间DGF的几率（未调整和调整后）没有差异。在美国接受肾移植的儿童中，肥胖的患病率正在上升。在这项针对小儿肾移植受者的全国性研究中，与接受肾移植的正常和体重过轻儿童相比，肥胖儿童的移植或患者生存率没有差异，DGF发生率也没有差异。
