肾移植前后的减肥手术：长期体重减轻和移植物结局。
Bariatric surgery before and after kidney transplantation: long-term weight loss and allograft outcomes.
机构信息
Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
出版信息
Surg Obes Relat Dis. 2019 Jun;15(6):935-941. doi: 10.1016/j.soard.2019.04.002.
BACKGROUND
Severe obesity is frequently a barrier to kidney transplantation, and kidney transplant recipients often have significant weight gain following transplantation.
OBJECTIVES
The goals of this study were to evaluate the long-term risks and benefits of bariatric surgery before and after kidney transplantation.
SETTING
University Hospital, United States.
METHODS
We performed a retrospective cohort study of 43 patients who had pretransplantation bariatric surgery and 21 patients who had posttransplantation bariatric surgery from 1994 to 2017 with propensity-score matching to identify matched controls using national registry data.
RESULTS
Body mass index at the time of transplantation was similar in patients who underwent bariatric surgery before versus after transplantation (32 versus 34 kg/m, P = .172). There was no significant difference in body mass index in the 5 years after bariatric surgery among patients who underwent bariatric surgery before versus after kidney transplantation (36 versus 32 kg/m, P = 0.814). Compared with matched controls, bariatric surgery before (n = 38) and after (n = 18) kidney transplantation was associated with a decreased risk of allograft failure (hazard ratio .31 [95% confidence interval .29-0.33] and .85 [95% confidence interval .85-.86] for pre- and posttransplant, respectively) and mortality (hazard ratio .57 [95% confidence interval .53-.61] and .80 [95% confidence interval .79-.82] for pre- and posttransplant, respectively).
CONCLUSIONS
Bariatric surgery before and after kidney transplantation results in similar maintenance of weight loss and improved long-term allograft survival compared with matched controls. Bariatric surgery appears to be a safe and reasonable approach to weight loss both before and after transplantation.
背景
严重肥胖症常成为肾移植的障碍，肾移植受者在移植后往往会显著增重。
目的
本研究旨在评估肾移植前后行减肥手术的长期风险和获益。
地点
美国某大学医院。
方法
我们对 1994 年至 2017 年间行术前减肥手术（43 例）和术后减肥手术（21 例）的 43 例患者进行了回顾性队列研究，并采用全国登记数据进行倾向评分匹配，以识别匹配对照。
结果
与移植后行减肥手术的患者相比，移植前行减肥手术的患者的体重指数（BMI）相似（32 与 34 kg/m²，P =.172）。与移植后行减肥手术的患者相比，移植前行减肥手术的患者在减肥手术后 5 年内 BMI 无显著差异（36 与 32 kg/m²，P = 0.814）。与匹配对照相比，肾移植前（n = 38）和肾移植后（n = 18）行减肥手术与降低同种异体移植物失败的风险相关（风险比分别为 0.31[95%置信区间 0.29-0.33]和 0.85[95%置信区间 0.85-0.86]）和死亡率（风险比分别为 0.57[95%置信区间 0.53-0.61]和 0.80[95%置信区间 0.79-0.82]）。
结论
与匹配对照相比，肾移植前后行减肥手术可使体重减轻得到相似的维持，并改善长期同种异体移植物的存活率。减肥手术似乎是一种安全且合理的减肥方法，既适用于移植前，也适用于移植后。
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