Outmani Loubna, Kimenai Hendrikus J A N, Roodnat Joke I, Leeman Marjolijn, Biter Ulas L, Klaassen René A, IJzermans Jan N M, Minnee Robert C
Division of HPB and Transplant Surgery, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Division of Nephrology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
Clin Transplant. 2021 Mar;35(3):e14208. doi: 10.1111/ctr.14208. Epub 2021 Jan 9.
Patients with class II and III obesity and end-stage renal disease are often ineligible for kidney transplantation (KTx) due to increased postoperative complications and technically challenging surgery. Bariatric surgery (BS) can be an effective solution for KTx candidates who are considered inoperable. The aim of this study is to evaluate outcomes of KTx after BS and to compare the outcomes to obese recipients (BMI ≥ 35 kg/m ) without BS. This retrospective, single-center study included patients who received KTx after BS between January 1994 and December 2018. The primary outcome was postoperative complications. The secondary outcomes were graft and patient survival. In total, 156 patients were included, of whom 23 underwent BS prior to KTx. There were no significant differences in postoperative complications. After a median follow-up of 5.1 years, death-censored graft survival, uncensored graft survival, and patient survival were similar to controls (log rank test p = .845, .659, and .704, respectively). Dialysis pre-transplantation (Hazard Ratio (HR) 2.55; 95%CI 1.03-6.34, p = .043) and diabetes (HR 2.41; 95%CI 1.11-5.22, p = .027) were independent risk factors for all-cause mortality. A kidney from a deceased donor was an independent risk factor for death-censored graft loss (HR 1.98; 95%CI 1.04-3.79, p = .038). Patients who received a KTx after BS have similar outcomes as obese transplant recipients.
II级和III级肥胖且患有终末期肾病的患者，由于术后并发症增加以及手术技术难度大，通常不符合肾移植（KTx）的条件。减重手术（BS）对于那些被认为无法进行手术的KTx候选者可能是一种有效的解决方案。本研究的目的是评估BS后KTx的结果，并将其与未接受BS的肥胖受者（BMI≥35 kg/m²）的结果进行比较。这项回顾性单中心研究纳入了1994年1月至2018年12月期间接受BS后进行KTx的患者。主要结局是术后并发症。次要结局是移植物和患者生存率。总共纳入了156例患者，其中23例在KTx之前接受了BS。术后并发症方面没有显著差异。中位随访5.1年后，死亡删失的移植物生存率、未删失的移植物生存率和患者生存率与对照组相似（对数秩检验p分别为0.845、0.659和0.704）。移植前透析（风险比（HR）2.55；95%置信区间1.03 - 6.34，p = 0.043）和糖尿病（HR 2.41；95%置信区间1.11 - 5.22，p = 0.027）是全因死亡率的独立危险因素。来自已故供体的肾脏是死亡删失的移植物丢失的独立危险因素（HR 1.98；95%置信区间1.04 - 3.79，p = 0.038）。接受BS后进行KTx的患者与肥胖移植受者的结局相似。
