减重手术在终末期器官疾病患者中实现移植：系统评价和荟萃分析。
Bariatric surgery to achieve transplant in end-stage organ disease patients: A systematic review and meta-analysis.
机构信息
University of Alabama at Birmingham Schools of Medicine, Department of Surgery, United States.
University of Alabama at Birmingham Schools of Medicine, Department of Surgery, United States.
出版信息
Am J Surg. 2020 Sep;220(3):566-579. doi: 10.1016/j.amjsurg.2020.04.041. Epub 2020 Jun 13.
BACKGROUND
As obesity prevalence grows, more end-stage organ disease patients will be precluded from transplant. Numerous reports suggest bariatric surgery in end-stage organ disease may help patients achieve weight loss sufficient for transplant listing.
METHODS
We performed a systematic review/meta-analysis of studies of bariatric surgery to achieve solid organ transplant listing.
RESULTS
Among 82 heart failure patients, 40.2% lost sufficient weight for listing, 29.3% were transplanted, and 8.5% had sufficient improvement with weight loss they no longer required transplantation. Among 28 end-stage lung disease patients, 28.6% lost sufficient weight for listing, 7.1% were transplanted, and 14.3% had sufficient improvement following weight loss they no longer required transplant. Among 41 cirrhosis patients, 58.5% lost sufficient weight for listing, 41.5% were transplanted, and 21.9% had sufficient improvement following weight loss they no longer required transplant. Among 288 end-stage/chronic kidney disease patients, 50.3% lost sufficient weight for listing and 29.5% were transplanted.
CONCLUSIONS
Small sample size and publication bias are limitations; however, bariatric surgery may benefit select end-stage organ disease patients with obesity that precludes transplant candidacy.
背景
随着肥胖症患病率的增加，将有更多的终末期器官疾病患者被排除在移植之外。许多报告表明，终末期器官疾病患者进行减肥手术可能有助于患者实现足以获得移植资格的体重减轻。
方法
我们对减肥手术以实现实体器官移植资格的研究进行了系统评价/荟萃分析。
结果
在 82 例心力衰竭患者中，有 40.2%的患者体重减轻足以获得资格，29.3%的患者接受了移植，8.5%的患者体重减轻足以改善，不再需要移植。在 28 例终末期肺病患者中，有 28.6%的患者体重减轻足以获得资格，7.1%的患者接受了移植，14.3%的患者体重减轻足以改善，不再需要移植。在 41 例肝硬化患者中，有 58.5%的患者体重减轻足以获得资格，41.5%的患者接受了移植，21.9%的患者体重减轻足以改善，不再需要移植。在 288 例终末期/慢性肾病患者中，有 50.3%的患者体重减轻足以获得资格，29.5%的患者接受了移植。
结论
样本量小和发表偏倚是其局限性；然而，减肥手术可能对肥胖导致无法获得移植资格的某些终末期器官疾病患者有益。
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