Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Metabolism. 2020 May;106:154204. doi: 10.1016/j.metabol.2020.154204. Epub 2020 Mar 13.
Short-term survival after orthotopic liver transplantation (OLT) has improved over the past decades, but long-term survival remains impaired. The effects of obesity on long-term survival after OLT are controversial. Because pre-transplant body mass index (BMI) can be confounded by ascites, we hypothesized that post-transplant BMI at 1 year could predict long-term survival.
A post-hoc analysis was performed of an observational cohort study consisting of adult recipients of a first OLT between 1993 and 2010. Baseline BMI was measured at 1-year post-transplantation to represent a stable condition. Recipients were stratified into normal weight (BMI < 25 kg/m), overweight (25 ≤ BMI ≤ 30 kg/m), and obese (BMI > 30 kg/m). Kaplan-Meier survival analyses were performed with log-rank testing, followed by multivariable Cox proportional hazards regression analysis.
Out of 370 included recipients, 184 had normal weight, 136 were overweight, and 50 were obese at 1-year post-transplantation. After median follow-up for 12.3 years, 107 recipients had died, of whom 46 (25%) had normal weight, 39 (29%) were overweight, and 22 (44%) were obese (log-rank P = 0.020). Obese recipients had a significantly increased mortality risk compared to normal weight recipients (HR 2.00, 95% CI 1.08-3.68, P = 0.027). BMI was inversely associated with 15 years patient survival (HR 1.08, 95% CI 1.03-1.14, P = 0.001 per kg/m), independent of age, gender, muscle mass, transplant characteristics, cardiovascular risk factors, kidney- and liver function.
Obesity at 1-year post-transplantation conveys a 2-fold increased mortality risk, which may offer potential for interventional strategies (i.e. dietary advice, lifestyle modification, or bariatric surgery) to improve long-term survival after OLT.
在过去的几十年中，原位肝移植（OLT）后的短期存活率有所提高，但长期存活率仍然较差。肥胖对 OLT 后长期存活率的影响存在争议。由于移植前的体重指数（BMI）可能会受到腹水的影响，我们假设移植后 1 年的 BMI 可以预测长期存活率。
对 1993 年至 2010 年间接受首次 OLT 的成人患者的观察队列研究进行了事后分析。在移植后 1 年测量基线 BMI，以代表稳定状态。将患者分为正常体重（BMI<25kg/m）、超重（25≤BMI≤30kg/m）和肥胖（BMI>30kg/m）。采用对数秩检验进行 Kaplan-Meier 生存分析，然后进行多变量 Cox 比例风险回归分析。
在 370 名纳入的受者中，184 名在移植后 1 年时体重正常，136 名超重，50 名肥胖。中位随访 12.3 年后，107 名受者死亡，其中 46 名（25%）体重正常，39 名（29%）超重，22 名（44%）肥胖（对数秩 P=0.020）。与体重正常的受者相比，肥胖的受者死亡风险显著增加（HR 2.00，95%CI 1.08-3.68，P=0.027）。BMI 与 15 年患者生存率呈负相关（HR 1.08，95%CI 1.03-1.14，每公斤/m 增加 P=0.001），独立于年龄、性别、肌肉量、移植特征、心血管危险因素、肾功能和肝功能。
移植后 1 年肥胖使死亡率增加 2 倍，这可能为干预策略（即饮食建议、生活方式改变或减肥手术）提供了改善 OLT 后长期存活率的机会。
