Department of Surgery, Houston Methodist Hospital, Houston, TX.
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Transplantation. 2020 Mar;104(3):632-639. doi: 10.1097/TP.0000000000002862.
Excessive weight (EW) gain is common after solid organ transplantation, but there is little information concerning obesity after pancreas transplantation. The study goal was to characterize EW gain after kidney-pancreas (KP) transplantation.
This was a retrospective single-center review of 100 KP recipients transplanted between September 2007 and June 2015.
The median percent weight gain for all recipients at 1 year posttransplant was 10% (interquartile range, 2.7%-19.3%) of baseline weight. EW gain, defined as greater than or equal to a 19% 1-year increase in weight, included all recipients (n = 26) above the upper limit of interquartile range for weight gain at 1 year. In multivariate analysis, recipient age <40 years, the use of tacrolimus/mammalian target of rapamycin immunosuppression, and an acute rejection event were independent risk factors for EW gain. At a mean follow-up of 43±23 months, there was no difference in patient or graft survival between the EW and non-EW cohorts. Although mean hemoglobin A1c levels between groups were equivalent, the EW versus non-EW cohort displayed a significant increase in mean insulin levels and a trend towards higher C-peptide levels. Criteria for posttransplant metabolic syndrome was met in 34.6% of EW versus 17.6% of non-EW cohorts (P = 0.07).
At intermediate-term follow-up, EW gain after KP transplantation was not associated with an increased risk of death or graft loss, although there was a trend toward a greater risk of posttransplant metabolic syndrome. There may be a metabolic consequence of successful pancreas transplantation that results in EW gain in a proportion of recipients, leading to an increased risk of long-term cardiovascular complications.
实体器官移植后体重过度增加（EW）很常见，但有关胰腺移植后肥胖的信息很少。本研究的目的是描述肾胰（KP）移植后 EW 的增加情况。
这是一项回顾性的单中心研究，纳入了 2007 年 9 月至 2015 年 6 月期间接受 KP 移植的 100 例患者。
所有受者移植后 1 年时的体重中位数增加了 10%（四分位距，2.7%-19.3%）基线体重。EW 增加定义为体重在 1 年内增加了 19%以上，包括所有受者（n=26）均超过体重增加 1 年的四分位距上限。多变量分析显示，受者年龄<40 岁、使用他克莫司/雷帕霉素免疫抑制剂和急性排斥反应是 EW 增加的独立危险因素。在平均随访 43±23 个月时，EW 和非 EW 组的患者或移植物存活率无差异。尽管两组的平均糖化血红蛋白水平相当，但 EW 与非 EW 组相比，平均胰岛素水平升高，C 肽水平呈升高趋势。EW 组符合移植后代谢综合征标准的比例为 34.6%，而非 EW 组为 17.6%（P=0.07）。
在中期随访中，KP 移植后 EW 的增加与死亡或移植物丢失的风险增加无关，但与移植后代谢综合征的风险增加呈趋势相关。成功的胰腺移植可能会导致部分受者出现 EW 增加，从而导致长期心血管并发症风险增加。
