Department of Biostatistics, Virginia Commonwealth, University, Richmond, VA, USA.
Division of Nephrology, Department of Medicine, Virginia Commonwealth, University, Richmond, VA, USA.
Transpl Int. 2019 Feb;32(2):206-217. doi: 10.1111/tri.13352. Epub 2018 Oct 30.
Simultaneous liver kidney transplantation (SLK) is the only curative option for patients with combined end stage liver and kidney disease. With the global obesity epidemic, an increasing number of obese patients are in need of SLK. However, the impact of pre-transplant obesity on outcomes after SLK is unknown. An analysis of the United States OPTN registry (Oct 1987 - June 2016) identified 7205 SLK transplants. Of these, 1677 patients were overweight/obese (OW, BMI 30-39) and 183 were morbidly obese (MO, BMI ≥40). 29% of patients had NASH in the MO group versus 16.4% and 4.7% in the OW and normal weight (NW) groups, respectively. The 1, 3 and 5 year overall patient survival, kidney and liver graft survivals were comparable between the three groups. Numerically higher rates of acute kidney rejection were reported in the MO group at 1 year [12.73%, 8.59%, and 10.05% for MO, OW and NW, respectively (P = 0.22)]. Multivariate analysis identified diagnosis of hepatitis C, donor age, diabetes mellitus, and delayed kidney transplant function but not BMI as risk factors for poor patient and both liver and kidney graft survival. Based on these findings, obesity should not be a contraindication for SLK even for patients with BMIs ≥ 40.
肝肾联合移植（SLK）是合并终末期肝肾功能衰竭患者的唯一根治性选择。随着全球肥胖症的流行，越来越多的肥胖患者需要进行 SLK。然而，移植前肥胖对 SLK 后结局的影响尚不清楚。对美国 OPTN 登记处（1987 年 10 月至 2016 年 6 月）的分析确定了 7205 例 SLK 移植。其中，1677 例超重/肥胖（OW，BMI30-39），183 例病态肥胖（MO，BMI≥40）。MO 组中有 29%的患者患有 NASH，而 OW 和正常体重（NW）组中分别有 16.4%和 4.7%的患者患有 NASH。三组患者的 1、3 和 5 年总生存率、肾和肝移植物存活率相当。MO 组在 1 年时报告的急性肾排斥反应发生率较高[12.73%、8.59%和 10.05%分别为 MO、OW 和 NW（P=0.22）]。多因素分析确定丙型肝炎诊断、供体年龄、糖尿病和延迟肾功能移植是影响患者和肝、肾移植物存活率的危险因素，而 BMI 不是。基于这些发现，肥胖不应成为 SLK 的禁忌症，即使 BMI≥40 的患者也是如此。
