Harhay Meera N, Chen Xiaomeng, Chu Nadia M, Norman Silas P, Segev Dorry L, McAdams-DeMarco Mara
Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.
Nephrol Dial Transplant. 2021 Sep 27;36(10):1927-1936. doi: 10.1093/ndt/gfab164.
Weight loss before kidney transplant (KT) is a known risk factor for weight gain and mortality, however, while unintentional weight loss is a marker of vulnerability, intentional weight loss might improve health. We tested whether pre-KT unintentional and intentional weight loss have differing associations with post-KT weight gain, graft loss and mortality.
Among 919 KT recipients from a prospective cohort study, we used adjusted mixed-effects models to estimate post-KT BMI trajectories, and Cox models to estimate death-uncensored graft loss, death-censored graft loss and all-cause mortality by 1-year pre-KT weight change category [stable weight (change ≤ 5%), intentional weight loss (loss > 5%), unintentional weight loss (loss > 5%) and weight gain (gain > 5%)].
The mean age was 53 years, 38% were Black and 40% were female. In the pre-KT year, 62% of recipients had stable weight, 15% had weight gain, 14% had unintentional weight loss and 10% had intentional weight loss. In the first 3 years post-KT, BMI increases were similar among those with pre-KT weight gain and intentional weight loss and lower compared with those with unintentional weight loss {difference +0.79 kg/m2/year [95% confidence interval (CI) 0.50-1.08], P < 0.001}. Only unintentional weight loss was independently associated with higher death-uncensored graft loss [adjusted hazard ratio (aHR) 1.80 (95% CI 1.23-2.62)], death-censored graft loss [aHR 1.91 (95% CI 1.12-3.26)] and mortality [aHR 1.72 (95% CI 1.06-2.79)] relative to stable pre-KT weight.
This study suggests that unintentional, but not intentional, pre-KT weight loss is an independent risk factor for adverse post-KT outcomes.
肾移植（KT）前体重减轻是体重增加和死亡的已知危险因素，然而，虽然非故意体重减轻是脆弱性的一个标志，但故意体重减轻可能会改善健康状况。我们测试了KT前非故意和故意体重减轻与KT后体重增加、移植物丢失和死亡率是否存在不同的关联。
在一项前瞻性队列研究的919名KT受者中，我们使用调整后的混合效应模型来估计KT后体重指数（BMI）轨迹，并使用Cox模型根据KT前1年的体重变化类别[体重稳定（变化≤5%）、故意体重减轻（减轻>5%）、非故意体重减轻（减轻>5%）和体重增加（增加>5%）]来估计未删失死亡的移植物丢失、删失死亡的移植物丢失和全因死亡率。
平均年龄为53岁，38%为黑人，40%为女性。在KT前一年，62%的受者体重稳定，15%体重增加，14%非故意体重减轻，10%故意体重减轻。在KT后的前3年，KT前体重增加和故意体重减轻者的BMI增加相似，与非故意体重减轻者相比更低{差异为+0.79kg/m²/年[95%置信区间（CI）0.50 - 1.OS]，P<0.001}。相对于KT前体重稳定，只有非故意体重减轻与更高的未删失死亡的移植物丢失[调整后风险比（aHR）1.80（95%CI 1.23 - 2.62）]、删失死亡的移植物丢失[aHR 1.91（95%CI 1.12 - 3.26）]和死亡率[aHR 1.72（95%CI 1.06 - 2.79）]独立相关。
本研究表明，KT前非故意而非故意体重减轻是KT后不良结局的独立危险因素。
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