Ercole Patrick M, Buchanan Paula M, Lentine Krista L, Burroughs Thomas E, Schnitzler Mark A, Modanlou Kian A
Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, MO.
Center for Outcomes Research, Saint Louis University, St. Louis, MO.
J Nephrol Ther. 2012;Suppl 4(SI Kidney Transplantation). doi: 10.4172/2161-0959.S4-003. Epub 2012 Jan 18.
Obesity presents an additional challenge to the procedure of and recovery from kidney transplantation. As the prevalence of transplant candidates with an elevated body mass index (BMI) grows, researchers need to examine and quantify the increased risks and additional costs associated with the full spectrum of body composition.
A retrospective cohort study design was used.
SETTING & PARTICIPANTS: Data from a private health insurance provider were linked with records from the Organ Procurement and Transplantation Network to examine costs and health outcomes following kidney transplantation.
BMI was used to predict costs and outcomes.
The primary outcome of interest was posttransplant cost defined as insurance charges. Secondary outcomes of interest included delayed graft function, graft failure, patient survival, and length of transplant hospitalization.
Categories of BMI followed selected cutoffs from World Health Organization International Classifications. Charges from recipient dialysis center, health providers, and treatment centers following transplant were summed during transplant hospitalization as well as each of three years following transplantation.
Rates of graft failure were significantly increased for underweight, overweight, obese, and morbidly obese recipients. Recipients with elevated BMI had a significantly longer length of transplant hospitalization and an increased rate of delayed graft function.
Our analysis was limited to the quality and availability of the data included in the registry. Though inexpensive and easy to calculate, BMI may not be the best measure of body composition. Finally, BMI measurement is cross-sectional at time of transplant thereby limiting the potential for fluctuation of BMI before and after transplantation.
The study results highlight the exponential concern associated with non-normal BMI for kidney transplant recipients. Transplant centers and insurance companies should consider funding weight management programs for transplant candidates as a means of obtaining preferred BMI and reducing costs associated with follow-up care.
肥胖给肾移植手术及术后恢复带来了额外挑战。随着体重指数（BMI）升高的移植候选者患病率不断增加，研究人员需要审视并量化与全谱身体组成相关的风险增加及额外成本。
采用回顾性队列研究设计。
将一家私人健康保险公司的数据与器官获取和移植网络的记录相链接，以研究肾移植后的成本和健康结果。
使用BMI预测成本和结果。
主要关注的结果是移植后成本，定义为保险费用。其他关注的次要结果包括移植肾功能延迟恢复、移植失败、患者存活以及移植住院时间。
BMI类别遵循世界卫生组织国际分类选定的临界值。将移植住院期间以及移植后三年中每年接受者透析中心、医疗服务提供者和治疗中心的费用相加。
体重过轻、超重、肥胖和病态肥胖的接受者移植失败率显著增加。BMI升高的接受者移植住院时间显著更长，移植肾功能延迟恢复率增加。
我们的分析限于登记处数据的质量和可得性。尽管BMI计算便宜且容易，但它可能不是身体组成的最佳衡量指标。最后，BMI测量是在移植时的横断面测量，因此限制了移植前后BMI波动的可能性。
研究结果凸显了肾移植受者BMI不正常所带来的指数级问题。移植中心和保险公司应考虑为移植候选者资助体重管理项目，作为获得理想BMI并降低后续护理相关成本的一种方式。
