Sureshkumar Kalathil K, Chopra Bhavna, Josephson Michelle A, Shah Pratik B, McGill Rita L
Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania.
Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois.
Am J Kidney Dis. 2021 Oct;78(4):501-510.e1. doi: 10.1053/j.ajkd.2021.02.332. Epub 2021 Apr 16.
RATIONALE & OBJECTIVE: The impact of extreme recipient obesity on long-term kidney transplant outcomes has been controversial. This study sought to evaluate the association of various levels of recipient obesity on kidney transplantation outcomes by comparing mate-kidney recipient pairs to address possible confounding effects of donor characteristics on posttransplant outcomes.
Nationwide observational cohort study using mate-kidney models.
SETTING & PARTICIPANTS: In analysis based on the Organ Procurement and Transplant Network/United Network of Organ Sharing database, 44,560 adult recipients of first-time deceased-donor kidney transplants from 2001 through 2016 were paired by donor.
Recipient body mass index (BMI) categorized as 18-25 (n = 12,446), >25-30 (n = 15,477), >30-35 (n = 11,144; obese), and >35 (n = 5,493; extreme obesity) kg/m.
Outcomes included patient survival, graft survival, death-censored graft survival, delayed graft function (DGF), and hospital length of stay.
Conditional logistic regression and stratified proportional hazards models were used to compare outcomes as odds ratios and hazard ratios (HRs), adjusted for recipient and transplant factors, using recipients with a BMI >35 kg/m as a reference.
At a median follow-up of 3.9 years, adjusted odds ratios for DGF were 0.42 (95% CI, 0.36-0.48), 0.55 (95% CI, 0.48-0.62), and 0.73 (95% CI, 0.64-0.83) for BMI 18-25, >25-30, and >30-35 kg/m, respectively (P < 0.001 for all). Death-censored graft failure was less frequent for BMI ≤25 and >25-30 kg/m (HRs of 0.66 [95% CI, 0.59-0.74] and 0.79 [95% CI, 0.70-0.88], respectively; P < 0.001 for both), but not for BMI >30-35 kg/m (HR, 0.91 [95% CI, 0.81-1.02]; P = 0.09). Length of stay and patient survival did not differ by recipient BMI.
Observational study with limited detail regarding potential confounders.
Despite an increased risk of DGF likely unrelated to donor organ quality, long-term transplant outcomes among recipients with a BMI >35 kg/m are similar to those among recipients with a BMI >30-35 kg/m, supporting a flexible approach to kidney transplantation candidacy in candidates with extreme obesity.
受体极度肥胖对肾移植长期预后的影响一直存在争议。本研究旨在通过比较配对肾移植受体对来评估不同程度的受体肥胖与肾移植预后之间的关联，以解决供体特征对移植后预后可能产生的混杂影响。
采用配对肾模型的全国性观察性队列研究。
基于器官获取与移植网络/器官共享联合网络数据库进行分析，2001年至2016年期间44560例首次接受死亡供体肾移植的成年受体按供体进行配对。
受体体重指数（BMI）分为18 - 25（n = 12446）、>25 - 30（n = 15477）、>30 - 35（n = 11144；肥胖）和>35（n = 5493；极度肥胖）kg/m²。
包括患者生存率、移植物生存率、死亡截尾移植物生存率、移植肾功能延迟恢复（DGF）和住院时间。
使用条件逻辑回归和分层比例风险模型，以BMI >35 kg/m²的受体为参照，将结果以比值比和风险比（HR）表示，并对受体和移植因素进行校正后比较。
在中位随访3.9年时，BMI为18 - 25、>25 - 30和>30 - 35 kg/m²的受体发生DGF的校正比值比分别为0.42（95%CI，0.36 - 0.48）、0.55（95%CI，0.48 - 0.62）和0.73（95%CI，0.64 - 0.83）（所有P < 0.001）。BMI≤25和>25 - 30 kg/m²的受体死亡截尾移植物失败的发生率较低（HR分别为0.66[95%CI，0.59 - 0.74]和0.79[95%CI，0.70 - 0.88]；两者P均< 0.001），但BMI >30 - 35 kg/m²的受体并非如此（HR，0.91[95%CI，0.81 - 1.02]；P = 0.09）。住院时间和患者生存率在不同BMI的受体之间无差异。
观察性研究，关于潜在混杂因素的细节有限。
尽管发生DGF的风险增加可能与供体器官质量无关，但BMI >35 kg/m²的受体的长期移植预后与BMI >30 - 35 kg/m²的受体相似，支持对极度肥胖的肾移植候选者采取灵活的肾移植候选资格评估方法。
