Chang Su-Hsin, Liu Xiaoyan, Carlsson Nils P, Park Yikyung, Colditz Graham A, Garonzik-Wang Jacqueline M, Chapman William C, Wellen Jason R, Doyle Maria B, Alhamad Tarek
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
Division of Biostatistics, Washington University School of Medicine, St. Louis, MO.
Transplant Direct. 2017 Jun 12;3(7):e172. doi: 10.1097/TXD.0000000000000681. eCollection 2017 Jul.
Several studies have shown that obese patients undergoing liver transplantation (LT) have an increased risk of mortality regardless of Model of End Stage Liver Disease (MELD) scores. The purpose of this study is to identify the range of body mass index (BMI) at LT associated with the lowest risks of posttransplant mortality by MELD category.
A retrospective cohort of patients aged 18 years or older from the Organ Procurement and Transplantation Network database undergoing LT between February 27, 2002, and December 31, 2013, was identified and followed up through March 14, 2014. Patients' MELD score at the time of transplantation was categorized into 10 or lower (MELD1), 11 to 18 (MELD2), 19 to 24 (MELD3), and 25 or higher (MELD4). Multivariable adjusted Cox proportional hazard analyses were conducted.
Among 48 226 patients in the analytic cohort (14.8% were in MELD1, 33.7% were in MELD2, 19.6% were in MELD3, and 32.0% were in MELD4), 25% died with mean follow-up of 1371 days. For MELD1, patient BMI ranging from 30 to 33 was associated with a better survival outcome than BMI less than 30 or 33 or greater; for MELD2, BMI ranging from 28 to 37 had a better survival outcome than BMI less than 28 or 37 or greater; for MELD3, the survival outcome improved with an increasing BMI; for MELD4, the survival outcome was not associated with patient BMI.
This study provides evidence that obesity in LT patients is not necessarily associated with higher posttransplantation mortality and highlights the importance of the interaction between BMI and MELD category to determine their survival likelihood.
多项研究表明，接受肝移植（LT）的肥胖患者，无论其终末期肝病模型（MELD）评分如何，死亡风险均会增加。本研究的目的是确定与不同MELD类别下移植后死亡风险最低相关的肝移植时体重指数（BMI）范围。
从器官获取与移植网络数据库中确定了2002年2月27日至2013年12月31日期间接受肝移植的18岁及以上患者的回顾性队列，并随访至2014年3月14日。将患者移植时的MELD评分分为10分及以下（MELD1）、11至18分（MELD2）、19至24分（MELD3）和25分及以上（MELD4）。进行多变量调整的Cox比例风险分析。
在分析队列的48226名患者中（14.8%为MELD1，33.7%为MELD2，19.6%为MELD3，32.0%为MELD4），25%的患者在平均1371天的随访期内死亡。对于MELD1，BMI在30至33之间的患者生存结局优于BMI低于30或高于33；对于MELD2，BMI在28至37之间的患者生存结局优于BMI低于28或高于37；对于MELD3，生存结局随BMI升高而改善；对于MELD4，生存结局与患者BMI无关。
本研究提供了证据，表明肝移植患者的肥胖不一定与移植后较高的死亡率相关，并强调了BMI与MELD类别之间相互作用对确定其生存可能性的重要性。
