Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
Rev Endocr Metab Disord. 2021 Dec;22(4):847-858. doi: 10.1007/s11154-021-09641-5. Epub 2021 Mar 17.
Obesity might be associated with mortality and clinical outcomes following transplantation; however, the direction of this relationship has not been well-recognized in youth. The aim of this systematic review and meta-analysis was to investigate the association of obesity with post-transplant mortality and clinical outcomes in children and adolescents. Following a systematic search of observational studies published by December 2018 in PubMed, Scopus, Embase, and Cochrane library, 15 articles with total sample size of 50,498 patients were included in the meta-analysis. The main outcome was mortality and secondary outcomes included acute graft versus host disease (GVHD), acute rejection, and overall graft loss. The pooled data analyses showed significantly higher odds of long term mortality (OR 1.30, 95% CI 1.15-1.48, P < 0.001, I = 50.3%), short term mortality (OR 1.79, 95% CI 1.19-2.70, P = 0.005, I = 59.6%), and acute GVHD (OR 2.13, 95% CI 1.5-3.02, P < 0.001, I = 1.7%) in children with obesity. There were no significant differences between patients with and without obesity in terms of acute rejection (OR 1.07, 95% CI 0.98-1.16, P = 0.132, I = 7.5%) or overall graft loss (OR 1.04, 95% CI 0.84-1.28, P = 0.740, I = 51.6%). This systematic review and meta-analysis has stated higher post-transplant risk of short and long term mortality and higher risk of acute GVHD in children with obesity compared to those without obesity. Future clinical trials are required to investigate the effect of pre-transplant weight management on post-transplant outcomes to provide insights into the clinical application of these findings. This may in turn lead to establish guidelines for the management of childhood obesity in transplantations.
肥胖可能与移植后的死亡率和临床结果有关；然而，在年轻人中，这种关系的方向尚未得到很好的认识。本系统评价和荟萃分析的目的是调查肥胖与儿童和青少年移植后死亡率和临床结果的关系。在系统搜索了截至 2018 年 12 月在 PubMed、Scopus、Embase 和 Cochrane 图书馆发表的观察性研究后，纳入了 15 项共纳入 50498 例患者的荟萃分析。主要结果是死亡率，次要结果包括急性移植物抗宿主病（GVHD）、急性排斥反应和整体移植物丢失。汇总数据分析显示，肥胖患者长期死亡率（OR 1.30，95%CI 1.15-1.48，P<0.001，I=50.3%）、短期死亡率（OR 1.79，95%CI 1.19-2.70，P=0.005，I=59.6%）和急性 GVHD（OR 2.13，95%CI 1.5-3.02，P<0.001，I=1.7%）的风险显著增加。肥胖患者与非肥胖患者在急性排斥反应（OR 1.07，95%CI 0.98-1.16，P=0.132，I=7.5%）或整体移植物丢失（OR 1.04，95%CI 0.84-1.28，P=0.740，I=51.6%）方面无显著差异。本系统评价和荟萃分析表明，与非肥胖患者相比，肥胖患者移植后短期和长期死亡率风险较高，急性 GVHD 风险较高。需要进行未来的临床试验来研究移植前体重管理对移植后结果的影响，以深入了解这些发现的临床应用。这反过来可能导致制定肥胖儿童移植管理指南。
