Institute of Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland; Center of Clinical Nursing Science, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
University Medical Center Groningen, Department of Gastroenterology and Hepatology, PO Box 30.0019700 RB Groningen, The Netherlands.
Transplant Rev (Orlando). 2019 Jan;33(1):39-47. doi: 10.1016/j.trre.2018.10.002. Epub 2018 Oct 12.
Weight gain and obesity can increase liver transplant (LTx) recipients' disease burden. We aimed to summarize and synthesize the evidence on pre- and post-transplant factors related to post-LTx BMI, weight gain, and obesity.
For this systematic review and meta-analysis we searched Medline (PubMed), Cochrane library, CINAHL, PsycINFO, and EMBASE for quantitative studies on 6 classes of factors (i.e., genetic, sociodemographic, behavioral, biomedical, psychological, and environmental) linked to body weight parameters in adult first-time LTx patients. A 19-item instrument was used for quality assessment. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for relationships investigated in ≥5 studies. Factors investigated in <5 studies were summarized and described.
Of 16,495 articles retrieved, 43 assessed factors in LTx. These examined 82 mainly biomedical and sociodemographic factors. However, variation between definitions allowed inclusion of only 2 factors (i.e., tacrolimus, cyclosporine) in our meta-analyses of 6 studies examining a shared parameter for body weight (median patient sample: 171 (range: 63-455); Europe n = 3; United States n = 3; publication years: 1997-2015). Neither tacrolimus (OR, 0.75; 95% CI, 0.47-1.21; p = 0.24) nor cyclosporine (OR, 1.40; 95% CI, 0.89-2.18; p = 0.14) were related significantly with post-LTx obesity.
Evidence on modifiable factors related to post-LTx body weight parameters is still scarce, as definition variability limits data extraction and pooling for meta-analyses. To facilitate future research, studies should apply theoretical frameworks to guide their study design, select variables of interest and systematically examine interrelationships among selected factors.
体重增加和肥胖会增加肝移植（LTx）受者的疾病负担。我们旨在总结和综合与 LTx 后 BMI、体重增加和肥胖相关的移植前和移植后因素的证据。
本系统评价和荟萃分析检索了 Medline（PubMed）、Cochrane 图书馆、CINAHL、PsycINFO 和 EMBASE 中的定量研究，这些研究涉及与成人首次 LTx 患者体重参数相关的 6 类因素（即遗传、社会人口统计学、行为、生物医学、心理和环境）。使用了 19 项工具进行质量评估。对于在≥5 项研究中调查的关系，计算了比值比（OR）及其 95%置信区间（CI）。在<5 项研究中调查的因素进行了总结和描述。
在检索到的 16495 篇文章中，有 43 篇文章评估了 LTx 中的因素。这些因素检查了 82 个主要的生物医学和社会人口统计学因素。然而，由于定义的差异，只有 2 个因素（即他克莫司、环孢素）被纳入了我们对 6 项研究的荟萃分析中，这些研究检查了体重的一个共享参数（中位患者样本：171（范围：63-455）；欧洲 n=3；美国 n=3；出版年份：1997-2015）。他克莫司（OR，0.75；95%CI，0.47-1.21；p=0.24）和环孢素（OR，1.40；95%CI，0.89-2.18；p=0.14）均与 LTx 后肥胖无显著相关性。
与 LTx 后体重参数相关的可改变因素的证据仍然很少，因为定义的差异限制了数据提取和荟萃分析的汇总。为了促进未来的研究，研究应应用理论框架来指导其研究设计，选择感兴趣的变量，并系统地检查所选因素之间的相互关系。
