Renal Transplant Unit, Pellegrin Hospital, Bordeaux, France.
Clinical Epidemiology Unit, Bordeaux University Hospital, Bordeaux, France.
BMC Nephrol. 2021 Jan 18;22(1):31. doi: 10.1186/s12882-020-02214-9.
Weight gain (mainly gain of fat mass) occurs quickly after successful kidney transplantation and is associated with metabolic complications (alterations of glycaemic control, hyperlipidaemia). Determinants of weight gain are multifactorial and are mainly related to the transplant procedure itself (glucocorticoid use, increased appetite). In the modern era of transplantation, one challenge is to limit these metabolic alterations by promoting gain of muscle mass rather than fat mass. This prospective study was performed to assess determinants of fat mass, fat-free mass and body cell mass changes after kidney transplantation with a focus on physical activity and nutritional behaviour before and after transplantation.
Patients were included at the time of listing for deceased donor kidney transplantation. Body composition was determined using dual X-ray absorptiometry and bioimpedance spectroscopy to assess fat mass, fat-free mass and body cell mass (= fat-free mass - extracellular water) at the time of inclusion, 12 months later, and 1, 6, 12 and 24 months after transplantation. Recall dietary data and physical activity level were also collected.
Eighty patients were included between 2007 and 2010. Sixty-five had a complete 24-month follow-up after kidney transplantation. Fat mass, fat-free mass and body cell mass decreased during the waiting period and early after kidney transplantation. The nadirs of body cell mass and fat-free mass occurred at 1 month and the nadir for fat mass occurred at 6 months. Maximum levels of all parameters of body composition were seen at 12 months, after which body cell mass and fat-free mass decreased, while fat mass remained stable. In multivariate analysis, male recipients, higher physical activity level and lower corticosteroid dose were significantly associated with better body cell mass recovery after kidney transplantation.
Lifestyle factors, such as physical activity level, together with low dose of corticosteroids seem to influence body composition evolution following kidney transplantation with recovery of body cell mass. Specific strategies to promote physical activity in kidney transplant recipients should be provided before and after kidney transplantation.
成功肾移植后体重迅速增加（主要是脂肪量增加），并伴有代谢并发症（血糖控制改变、血脂异常）。体重增加的决定因素是多因素的，主要与移植手术本身有关（使用糖皮质激素、食欲增加）。在移植的现代时代，一个挑战是通过促进肌肉质量而不是脂肪质量的增加来限制这些代谢改变。这项前瞻性研究旨在评估肾移植后脂肪量、去脂体重和细胞内液量变化的决定因素，重点关注移植前后的身体活动和营养行为。
在接受已故供体肾移植的患者中进行了这项研究。使用双能 X 射线吸收法和生物电阻抗谱法来评估脂肪量、去脂体重和细胞内液量（=去脂体重-细胞外液），在纳入时、12 个月后、移植后 1、6、12 和 24 个月进行评估。还收集了回忆性饮食数据和身体活动水平。
2007 年至 2010 年间，80 例患者被纳入研究。65 例患者在肾移植后完成了完整的 24 个月随访。在等待期和肾移植早期，脂肪量、去脂体重和细胞内液量减少。细胞内液量和去脂体重的最低点发生在 1 个月，而脂肪量的最低点发生在 6 个月。所有身体成分参数的最高水平出现在 12 个月，之后细胞内液量和去脂体重下降，而脂肪量保持稳定。在多变量分析中，男性受者、更高的身体活动水平和更低的皮质激素剂量与肾移植后细胞内液量更好的恢复显著相关。
生活方式因素，如身体活动水平，以及低剂量的皮质激素，似乎会影响肾移植后身体成分的演变，恢复细胞内液量。应在肾移植前后为肾移植受者提供促进身体活动的具体策略。
