Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, USA.
Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA.
Clin Transplant. 2018 May;32(5):e13232. doi: 10.1111/ctr.13232. Epub 2018 Apr 10.
Body mass index (BMI) > 35-40 kg/m is often a contraindication, while Roux-en-Y gastric bypass (RYGB) is performed to enable kidney transplantation. This single-center retrospective study evaluated pre- and post-transplant outcomes of 31 morbidly obese patients with end-stage renal disease having RYGB before kidney transplantation between July 2009 and June 2014. Fourteen RYGB patients were subsequently transplanted. Nineteen recipients not having GB with a BMI ≥ 36 kg/m at transplantation were used as historical controls. Mean BMI (±SE) before RYGB was 43.5 ± 0.7 kg/m (range: 35.4-50.5 kg/m ); 87.1% (27/31) achieved a BMI < 35 kg/m . The percentage having improved diabetes/hypertension control was 29.0% (9/31); 25.8% (8/31) had complications (mostly minor) after RYGB. Among transplanted patients, blacks/Hispanics comprised 78.6% (11/14) and 84.2% (16/19) of RYGB and controls; 57.1% (8/14) and 63.2% (12/19) had a (mostly long-standing) pretransplant history of diabetes. While biopsy-proven acute rejection (BPAR) occurred significantly higher among RYGB vs control patients (6/14 vs 3/19, P = .03), patients developing T-cell BPAR were also significantly more likely to have a tacrolimus (TAC) trough level < 4.0 ng/mL within 3 weeks of T-cell BPAR (P = .0007). In Cox's model, the impact of having a TAC level < 4.0 ng/mg remained significant (P = .007) while the effect of RYGB was no longer significant (P = .13). Infections, graft, and patient survival were not significantly different. Despite obvious effectiveness in achieving weight loss, RYGB will need more careful post-transplant monitoring given the observed higher BPAR rate.
体重指数（BMI）>35-40kg/m² 通常是一个禁忌症，而 Roux-en-Y 胃旁路（RYGB）则用于进行肾移植。这项单中心回顾性研究评估了 2009 年 7 月至 2014 年 6 月间 31 例患有终末期肾病的病态肥胖患者在接受肾移植前进行 RYGB 的移植前和移植后结果。随后有 14 例 RYGB 患者接受了移植。19 例接受了肾移植，但 BMI≥36kg/m² 的患者作为历史对照。RYGB 前的平均 BMI（±SE）为 43.5±0.7kg/m²（范围：35.4-50.5kg/m²）；87.1%（27/31）的患者 BMI<35kg/m²。糖尿病/高血压控制改善的比例为 29.0%（9/31）；25.8%（8/31）在 RYGB 后出现并发症（大多为轻微）。在接受移植的患者中，黑人和西班牙裔占 14 例中的 78.6%（11/14）和 RYGB 和对照组中的 84.2%（16/19）；57.1%（8/14）和 63.2%（12/19）在移植前有（大多为长期）糖尿病史。虽然 RYGB 患者的活检证实的急性排斥反应（BPAR）发生率明显高于对照组（6/14 比 3/19，P=0.03），但发生 T 细胞 BPAR 的患者在 T 细胞 BPAR 后 3 周内 Tacrolimus（TAC）谷浓度<4.0ng/mL 的可能性也明显更高（P=0.0007）。在 Cox 模型中，TAC 浓度<4.0ng/ml 的影响仍然显著（P=0.007），而 RYGB 的影响不再显著（P=0.13）。感染、移植物和患者生存率无显著差异。尽管 RYGB 在实现体重减轻方面效果明显，但鉴于观察到的更高的 BPAR 发生率，在移植后需要更仔细的监测。
