Department of Surgery, Temple University Hospital, Suite, 3401 North Broad Street, Philadelphia, PA, 19140, USA.
Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, 19140, USA.
Obes Surg. 2020 Jun;30(6):2313-2324. doi: 10.1007/s11695-020-04490-8.
Obesity is a risk factor for poor patient outcomes after organ transplantation (TXP). While metabolic and bariatric surgery (MBS) is safe and effective in treating severe obesity, the role of MBS in transplant patients continues to evolve.
A retrospective analysis was performed of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) patients in the 2017 Metabolic and Bariatric Surgery Accreditation Quality and Improvement Project (MBSAQIP) database. Propensity and case-control matching, and multivariable logistic regression were performed for 30-day post-operative outcomes.
A total of 336 transplant patients were compared with 157,413 patients without transplant. Propensity and case-control matching reveal no significant differences in mortality (p > 0.2). However, case-control matching revealed longer operative time (104 min versus 76 min, p < 0.001), increased length of stay (2 days versus 1 day, p < 0.05), perioperative transfusions (2% versus 0.22%, p = 0.009), and leak rates (2.2% versus 0.55%, p = 0.02) in the transplant cohort. On multivariable regression analysis, prior transplantation was associated with higher rates of overall (OR 1.6, p = 0.007) and bariatric-related morbidity (OR 1.78, p = 0.004), leak (OR 3.47, p = 0.0027), and surgical site infection (OR 3.32, p = 0.004). Prior transplantation did not predict overall (p = 0.55) nor bariatric-related mortality (p = 0.99).
MBS in prior solid organ transplantation patients is overall safe, but is associated with increased operative time and length of stay, as well as higher rates of some post-operative morbidity.
肥胖是器官移植（TXP）后患者预后不良的一个危险因素。虽然代谢和减重手术（MBS）在治疗严重肥胖症方面是安全有效的，但 MBS 在移植患者中的作用仍在不断发展。
对 2017 年代谢和减重手术认证质量和改进项目（MBSAQIP）数据库中的袖状胃切除术（SG）和 Roux-en-Y 胃旁路术（RYGB）患者进行回顾性分析。对 30 天术后结果进行倾向评分匹配和病例对照匹配，并进行多变量逻辑回归分析。
共比较了 336 例移植患者和 157413 例无移植患者。倾向评分匹配和病例对照匹配均显示死亡率无显著差异（p>0.2）。然而，病例对照匹配显示移植组手术时间较长（104 分钟比 76 分钟，p<0.001），住院时间延长（2 天比 1 天，p<0.05），围手术期输血（2%比 0.22%，p=0.009）和漏率（2.2%比 0.55%，p=0.02）较高。多变量回归分析显示，既往移植与总体（OR 1.6，p=0.007）和减重相关发病率（OR 1.78，p=0.004）、漏（OR 3.47，p=0.0027）和手术部位感染（OR 3.32，p=0.004）的发生率较高相关。既往移植与总体死亡率（p=0.55）或减重相关死亡率（p=0.99）无关。
MBS 在既往实体器官移植患者中总体上是安全的，但与手术时间和住院时间延长以及某些术后发病率增加有关。
