严重肥胖的肾移植受者接受移植前减肥手术的结果：一项长期随访研究。
Outcomes of kidney transplant recipients who underwent pre-transplant bariatric surgery for severe obesity: a long-term follow-up study.
机构信息
Multi-organ Transplant Program, Department of Surgery, McGill University, Montreal, QC, Canada.
Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, QC, Canada.
出版信息
Surg Endosc. 2023 Jan;37(1):494-502. doi: 10.1007/s00464-022-09552-9. Epub 2022 Aug 24.
BACKGROUND
Kidney transplantation (KT) is the preferred therapy for end-stage renal disease (ESRD). While a major cause for ESRD, obesity is also a key obstacle to candidacy for KT. Bariatric surgery, particularly sleeve gastrectomy (SG), is increasingly used to improve access to KT in patients with obesity, but the literature especially on outcomes post-KT remains lacking. We aimed to provide a long-term follow-up analysis of efficacy and outcomes of a previously described cohort of patients with obesity, who had SG as a means for access to KT.
METHODS
This is a single-center retrospective follow-up study of 32 patients with advanced chronic kidney disease or ESRD, who were referred and underwent SG between 2013 and 2018 as an access strategy to KT. The primary outcome was successful KT. Ninety-day outcomes, long-term graft function, and changes in weight and obesity-related comorbidities after KT were assessed. Descriptive statistics are presented as count (percentage) or median (interquartile range).
RESULTS
At baseline, 18 (56%) were male with a median age and BMI of 51 (11) years and 42.3 (5.2) kg/m, respectively. Median follow-up time post-SG was 53 (58) months. At last follow-up, 23 (72%) patients received KT. Median time to KT was 16 (20) months and BMI was 34.0 (5.1) kg/m at time of transplant. At KT, 13 (57%) and 20 (87%) had diabetes and hypertension, respectively. Median follow-up post-KT was 16 (47) months. There was one graft loss requiring return to dialysis. At 5-year post-KT, median serum creatinine was 136 (66) µmol/l. At last follow-up post-KT, median BMI remained at 33.7 (7.6) kg/m. Among patients with diabetes and hypertension, 7/13 (54%) and 5/20 (25%) had either improvement or remission of their comorbidities, respectively.
CONCLUSION
SG is an effective strategy to improve access to KT in patients with severe obesity. Transplant recipients also continue to benefit from sustained weight loss and improved related comorbidities that may positively impact their graft function after KT.
背景
肾移植（KT）是终末期肾病（ESRD）的首选治疗方法。肥胖是导致 ESRD 的主要原因之一，也是 KT 候选资格的关键障碍。减重手术，特别是袖状胃切除术（SG），越来越多地用于改善肥胖患者接受 KT 的机会，但关于 KT 后结果的文献仍然缺乏。我们旨在对以前描述的一组肥胖患者进行长期随访分析，这些患者通过 SG 作为接受 KT 的手段。
方法
这是一项单中心回顾性随访研究，纳入了 2013 年至 2018 年间因肥胖而接受 SG 作为 KT 治疗手段的 32 例进展期慢性肾脏病或 ESRD 患者。主要结局为成功 KT。评估了 90 天结局、长期移植物功能以及 KT 后体重和肥胖相关合并症的变化。描述性统计数据以计数（百分比）或中位数（四分位距）表示。
结果
基线时，18 例（56%）为男性，中位年龄和 BMI 分别为 51（11）岁和 42.3（5.2）kg/m2。SG 后中位随访时间为 53（58）个月。末次随访时，23 例（72%）患者接受了 KT。中位 KT 时间为 16（20）个月，移植时 BMI 为 34.0（5.1）kg/m2。在 KT 时，13 例（57%）和 20 例（87%）分别患有糖尿病和高血压。KT 后中位随访时间为 16（47）个月。有 1 例移植物失功，需要返回透析。KT 后 5 年，中位血清肌酐为 136（66）µmol/L。KT 后末次随访时，中位 BMI 仍为 33.7（7.6）kg/m2。在患有糖尿病和高血压的患者中，分别有 7/13（54%）和 5/20（25%）例患者的合并症得到改善或缓解。
结论
SG 是改善严重肥胖患者 KT 机会的有效策略。移植受者也继续受益于持续的体重减轻和相关合并症的改善，这可能对 KT 后移植物功能产生积极影响。
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