Fagenson Alexander M, Mazzei Michael, Edwards Michael A
Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania.
Department of Surgery, Mayo Clinic, Jacksonville, Florida.
J Surg Res. 2020 Oct;254:294-299. doi: 10.1016/j.jss.2020.04.024. Epub 2020 Jun 2.
Corticosteroids have been a mainstay of immunosuppression in patients after solid organ transplantation. Due to deleterious effects, there is a push to minimize steroid use. The impact of corticosteroid use on prior solid organ transplant patients undergoing metabolic and bariatric surgery (MBS) is unknown. The aim of this study was to determine if corticosteroid use independently impacts surgical outcomes after MBS in solid organ transplant patients.
A retrospective analysis was performed on patients undergoing sleeve gastrectomy and Roux-en-Y gastric bypass in the 2017 Metabolic and Bariatric Surgery Accreditation Quality and Improvement Project Participant Use File database. Patients with a history of solid organ transplantation were identified and further stratified by corticosteroid use. Univariable and multivariable regression for multiple postoperative outcomes were performed.
Overall findings are summarized in visual abstract. Of 382 prior solid organ transplant patients, 42% (n = 160) were on corticosteroids. Patients on corticosteroids had significantly higher overall morbidity (16% versus 9%, P < 0.05). After multivariable analysis, corticosteroid use had a two-fold increase in overall morbidity (odds ratio 2.05, P = 0.0034) but without an increased risk for overall morbidity related to MBS (odds ratio 2.06, P = 0.061).
Solid organ transplant patients undergoing MBS on corticosteroids have a significantly increased rate of overall morbidity (P < 0.05) but not morbidity related to bariatric surgery.
皮质类固醇一直是实体器官移植患者免疫抑制的主要手段。由于其有害影响，目前正努力尽量减少类固醇的使用。皮质类固醇的使用对先前接受代谢和减重手术（MBS）的实体器官移植患者的影响尚不清楚。本研究的目的是确定皮质类固醇的使用是否独立影响实体器官移植患者MBS后的手术结局。
对2017年代谢和减重手术认证质量与改进项目参与者使用文件数据库中接受袖状胃切除术和Roux-en-Y胃旁路术的患者进行回顾性分析。确定有实体器官移植史的患者，并根据皮质类固醇的使用情况进一步分层。对多个术后结局进行单变量和多变量回归分析。
总体结果总结在可视化摘要中。在382例先前的实体器官移植患者中，42%（n = 160）使用皮质类固醇。使用皮质类固醇的患者总体发病率显著更高（16%对9%，P < 0.05）。多变量分析后，使用皮质类固醇使总体发病率增加两倍（比值比2.05，P = 0.0034），但与MBS相关的总体发病率风险未增加（比值比2.06，P = 0.061）。
接受MBS且使用皮质类固醇的实体器官移植患者总体发病率显著增加（P < 0.05），但与减重手术相关的发病率未增加。
