Institute of Nursing Science, University of Basel, Basel, Switzerland.
Center for Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.
Transpl Int. 2018 Nov;31(11):1254-1267. doi: 10.1111/tri.13308. Epub 2018 Jul 9.
Weight gain after liver transplantation (LTx) facilitates development of new-onset obesity; however, its risk factors and outcomes are poorly understood. We identified the impact of new-onset obesity on cardiovascular events (CVEs) and patient survival, and risk factors for new-onset obesity. Multiple Cox regression models examined risk factors for CVEs, patient survival, and new-onset obesity in 253 adults (mean age 52.2 ± 11.6 years, male gender 63.6%, mean follow up 5.7 ± 2.1 years). Cumulative incidence of post-LTx CVE was 28.1%; that of new-onset obesity was 21.3%. Regardless of CVE at LTx, post-LTx CVEs were predicted by new-onset obesity [Hazard Ratio (HR), 2.95; P = 0.002] and higher age at LTx (HR, 1.05; P < 0.001). In patients without known pre-LTx CVEs (n = 214), risk factors for post-LTx CVEs were new-onset obesity (HR, 2.59; P = 0.014) and higher age (HR, 1.04; P = 0.001). Survival was not associated with new-onset obesity (P = 0.696). Alcoholic liver disease predicted new-onset obesity (HR, 3.37; P = 0.025), female gender was protective (HR, 0.39; P = 0.034). In 114 patients with available genetic data, alcoholic liver disease (HR, 12.82; P = 0.014) and hepatocellular carcinoma (HR, 10.02; P = 0.048) predicted new-onset obesity, and genetics remained borderline significant (HR, 1.07; P = 0.071). Early introduction of post-LTx weight management programs may suggest a potential pathway to reduce CVE risk.
肝移植（LTx）后体重增加会促进新发肥胖的发生；然而，其风险因素和结果尚不清楚。我们确定了新发肥胖对心血管事件（CVE）和患者生存的影响，以及新发肥胖的风险因素。在 253 名成年人（平均年龄 52.2 ± 11.6 岁，男性占 63.6%，平均随访 5.7 ± 2.1 年）中，使用多个 Cox 回归模型检查了 CVE、患者生存和新发肥胖的风险因素。LTx 后新发 CVE 的累积发生率为 28.1%；新发肥胖的发生率为 21.3%。无论 LTx 时是否发生 CVE，新发肥胖均可预测 LTx 后 CVE [风险比（HR），2.95；P = 0.002]和 LTx 时年龄较高（HR，1.05；P < 0.001）。在无已知 LTx 前 CVE 的患者（n = 214）中，LTx 后 CVE 的危险因素是新发肥胖（HR，2.59；P = 0.014）和年龄较高（HR，1.04；P = 0.001）。新发肥胖与生存无关（P = 0.696）。酒精性肝病预测新发肥胖（HR，3.37；P = 0.025），女性是保护性的（HR，0.39；P = 0.034）。在 114 名具有可用遗传数据的患者中，酒精性肝病（HR，12.82；P = 0.014）和肝细胞癌（HR，10.02；P = 0.048）预测了新发肥胖，且遗传因素仍具有边缘显著性（HR，1.07；P = 0.071）。早期引入 LTx 后体重管理方案可能提示降低 CVE 风险的潜在途径。
