Yin Saifu, Wu Linyan, Huang Zhongli, Fan Yu, Lin Tao, Song Turun
Urology Department, Urology Research Institute, Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.
Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.
Surgery. 2022 May;171(5):1396-1405. doi: 10.1016/j.surg.2021.10.024. Epub 2021 Nov 24.
Exact dose-response relationship between body mass index at transplantation and clinical outcomes after kidney transplantation remained unclear, and no specific body mass index threshold and pretransplant weight loss aim were recommended for kidney transplantation candidates among transplant centers.
PubMed, Embase, Web of Science, and Cochrane Library were searched for literature published up to December 31, 2019. The two-stage, random effect meta-analysis was performed to estimate the dose-response relationship between body mass index and clinical outcomes after kidney transplantation.
Ninety-four studies were included for qualitative assessment and 50 for dose-response meta-analyses. There was a U-shaped relationship between graft loss, patient death, and body mass index. Body mass index with the lowest risk of graft loss was 25.2 kg/m, and preferred body mass index range was 22-28 kg/m. Referring to a body mass index of 22 kg/m, the risk of graft loss was 1.088, 0.981, 1.003, and 1.685 for a body mass index of 18, 24, 28, and 40 kg/m, respectively. Body mass index with the lowest risk of patient death was 24.7 kg/m, and preferred body mass index range was 22-27 kg/m. Referring to a body mass index of 22 kg/m, the patient death risk was 1.115, 0.981, 1.032, and 2.634 for a body mass index of 18, 24, 28, and 40 kg/m, respectively. J-shaped relationships were observed between body mass index and acute rejection, delayed graft function, primary graft nonfunction, and de novo diabetes. Pair-wise comparisons showed that higher body mass index was also a risk factor for cardiovascular diseases, hypertension, infection, longer length of hospital stay, and lower estimated glomerular filtration rate level.
Underweight and severe obesity at transplantation are associated with a significantly increased risk of graft loss and patient death. A target body mass index at kidney transplantation is 22-27 kg/m.
肾移植时的体重指数与肾移植后临床结局的确切剂量反应关系仍不明确，各移植中心对于肾移植候选者未推荐特定的体重指数阈值及移植前体重减轻目标。
检索PubMed、Embase、Web of Science和Cochrane图书馆中截至2019年12月31日发表的文献。进行两阶段随机效应荟萃分析以估计肾移植后体重指数与临床结局之间的剂量反应关系。
纳入94项研究进行定性评估，50项进行剂量反应荟萃分析。移植肾丢失、患者死亡与体重指数之间呈U形关系。移植肾丢失风险最低的体重指数为25.2kg/m²，理想体重指数范围为22-28kg/m²。以体重指数22kg/m²为参照，体重指数为18、24、28和40kg/m²时，移植肾丢失风险分别为1.088、0.981、1.003和1.685。患者死亡风险最低的体重指数为24.7kg/m²，理想体重指数范围为22-27kg/m²。以体重指数22kg/m²为参照，体重指数为18、24、28和40kg/m²时，患者死亡风险分别为1.115、0.981、1.032和2.634。体重指数与急性排斥反应、移植肾功能延迟恢复、原发性移植肾无功能及新发糖尿病之间呈J形关系。两两比较显示，较高的体重指数也是心血管疾病、高血压、感染、住院时间延长及估计肾小球滤过率水平降低的危险因素。
移植时体重过轻和严重肥胖与移植肾丢失和患者死亡风险显著增加相关。肾移植时的目标体重指数为22-27kg/m²。
