Giorgakis Emmanouil, Tedeschi Michele, Bonaccorsi-Riani Eliano, Khorsandi Shirin Elizabeth, Menon Krishna, Vilca-Melendez Hector, Jassem Wayel, Srinivasan Parthi, Prachalias Andreas, Heaton Nigel
Institute of Liver Studies, King's College Hospital, London, United Kingdom.
Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA.
Ann Transplant. 2017 Oct 13;22:611-621. doi: 10.12659/aot.903475.
BACKGROUND This is the largest UK-based study on the effect of recipient body mass index (BMI) and its extremes (BMI <18.5 and BMI ≥35 kg/m²) on liver transplant (LT) outcomes. Its purpose was to analyze the BMI effect on post-LT mortality, graft loss, primary non-function (PNF), and graft vascular and biliary complications. MATERIAL AND METHODS Data were retrieved from a single-center LT database of 2,115 consecutive patients receiving first LT during period February 2004 to September 2015. Survivals were compared across the BMI groups; the effects of recipient BMI on survival, PNF, and graft vascular and biliary complications were analyzed via regression. RESULTS Autoimmune disease and nonalcoholic steatohepatitis were prevalent among underweight and morbidly obese adults, respectively. Graft survival was similar across BMI classes at 30 days and in 1, 2, 5, and 10 years (p=0.75) and on obese versus non-obese (p=0.33). BMI <35 kg/m² versus BMI ≥35 kg/m² mean graft survival was similar (p=0.84). BMI <18.5 kg/m² recipients tended to have inferior mean graft and patient survivals; however, the difference was non-significant (p=0.09 and p=0.1 respectively). BMI <18.5 kg/m² recipients were at higher risk of hepatic artery thrombosis (HR, 1.73, 95% CI 1.73-3, p<0.05). Adult underweight status was an independent HAT risk factor (HR 3, 95% CI 1-8.6, p=0.046). BMI class did not affect ischemic cholangiopathy risk (p=0.84). However, the overall biliary complication risk increased by 3% for every 1 kg/m² BMI rise. CONCLUSIONS Post-LT survival is independent of recipient BMI. Underweight status is linked to higher HAT risk. Biliary complication risk increases with rising recipient BMI. After appropriate recipient selection, recipient BMI extremes are not a contraindication for LT.
背景 这是英国规模最大的一项关于受者体重指数（BMI）及其极端情况（BMI<18.5以及BMI≥35kg/m²）对肝移植（LT）结局影响的研究。其目的是分析BMI对肝移植术后死亡率、移植物丢失、原发性无功能（PNF）以及移植物血管和胆道并发症的影响。材料与方法 数据取自2004年2月至2015年9月期间接受首次肝移植的2115例连续患者的单中心肝移植数据库。比较各BMI组的生存率；通过回归分析受者BMI对生存率、PNF以及移植物血管和胆道并发症的影响。结果 自身免疫性疾病和非酒精性脂肪性肝炎分别在体重过轻和病态肥胖的成年人中较为普遍。各BMI类别在30天以及1、2、5和10年时的移植物生存率相似（p=0.75），肥胖与非肥胖者之间也相似（p=0.33）。BMI<35kg/m²与BMI≥35kg/m²的平均移植物生存率相似（p=0.84）。BMI<18.5kg/m²的受者平均移植物和患者生存率往往较低；然而，差异无统计学意义（分别为p=0.09和p=0.1）。BMI<18.5kg/m²的受者肝动脉血栓形成风险较高（HR，1.73，95%CI 1.73 - 3，p<0.05）。成年体重过轻状态是肝动脉血栓形成的独立危险因素（HR 3，95%CI 1 - 8.6，p=0.046）。BMI类别不影响缺血性胆管病风险（p=0.84）。然而，BMI每升高1kg/m²，总体胆道并发症风险增加3%。结论 肝移植术后生存率与受者BMI无关。体重过轻状态与较高的肝动脉血栓形成风险相关。胆道并发症风险随受者BMI升高而增加。经过适当的受者选择后，受者BMI极端情况并非肝移植的禁忌证。
