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中度肥胖患者肾移植术后早期并发症及结局

Early Postoperative Complications and Outcomes of Kidney Transplantation in Moderately Obese Patients.

作者信息

Warzyszyńska Karola, Zawistowski Michał, Karpeta Edyta, Ostaszewska Agata, Jonas Maurycy, Kosieradzki Maciej

机构信息

Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.

Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.

出版信息

Transplant Proc. 2020 Oct;52(8):2318-2323. doi: 10.1016/j.transproceed.2020.02.110. Epub 2020 Apr 4.

Abstract

BACKGROUND

Obese renal transplant recipients (body mass index [BMI] ≥30 kg/m) are at risk of delayed graft function and postoperative complications, such as infections or delayed wound healing. There is also a tendency to exclude extremely obese patients from transplantation (KTx). Nonetheless, no association between obesity and increased mortality has been reported. The aim of this study is to evaluate the effect of BMI on the most common surgical and infectious complications after KTx.

MATERIALS AND METHODS

An observational study in 872 patients transplanted from 2010-2017 was conducted. Median BMI was 24.6 (13.9-34.3), and 8.3% of the group was obese. Patient records were searched for early postoperative complications: lymphocele or hematoma (>33 mL), urinary leakage, or urinary tract infection (UTI). Mann-Whitney U and χ or Fisher exact tests were used. P < .05 was considered statistically significant. The study complies with the Helsinki Congress and the Istanbul Declaration.

RESULTS

Renal primary nonfunction was observed in 1.4% (12/872) of patients. Surgical or infectious complications occurred in 52.7% (453/860) of patients. No correlation between BMI and complication rate was noted. Complications were observed in 56.9% (41/72) of obese vs 52.3% (412/788) of nonobese patients (P = .448), including lymphocele in 15.3% vs 16.4% (P = .810), hematoma in 22.2% vs 19.2% (P = .530), urinary leakage in 1.4% vs 4.6% (P = .203), and UTI in 31.9% vs 32.9% (P = .873), respectively.

CONCLUSIONS

Recipient's BMI has no significant association with the most common surgical complications after KTx. There is no need to delay KTx in moderately obese patients.

摘要

背景

肥胖的肾移植受者(体重指数[BMI]≥30kg/m²)存在移植肾功能延迟恢复及术后并发症的风险,如感染或伤口愈合延迟。此外,存在将极度肥胖患者排除在肾移植(KTx)之外的趋势。然而,尚未有肥胖与死亡率增加之间存在关联的报道。本研究的目的是评估BMI对肾移植术后最常见的外科及感染性并发症的影响。

材料与方法

对2010年至2017年期间接受移植的872例患者进行了一项观察性研究。BMI中位数为24.6(13.9 - 34.3),该组中8.3%为肥胖患者。检索患者记录以查找术后早期并发症:淋巴囊肿或血肿(>33mL)、尿漏或尿路感染(UTI)。采用曼-惠特尼U检验和χ²检验或费舍尔精确检验。P <.05被认为具有统计学意义。本研究符合赫尔辛基大会和伊斯坦布尔宣言。

结果

1.4%(12/872)的患者出现移植肾原发性无功能。52.7%(453/860)的患者发生了外科或感染性并发症。未发现BMI与并发症发生率之间存在相关性。肥胖患者中有56.9%(41/72)发生并发症,非肥胖患者中有52.3%(412/788)发生并发症(P =.448),其中淋巴囊肿发生率分别为15.3%和16.4%(P =.810),血肿发生率分别为22.2%和19.2%(P =.530),尿漏发生率分别为1.4%和4.6%(P =.203),尿路感染发生率分别为31.9%和32.9%(P =.873)。

结论

肾移植受者的BMI与肾移植术后最常见的外科并发症无显著关联。对于中度肥胖患者,无需延迟肾移植。

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