Toledo Enrique, Canal Gema, Sánchez Sara, Echeverri Juan, Fernández Roberto, Del Mar Achalandabaso Mª, Anderson Edward J, Castillo Federico, Rodríguez Juan Carlos
General Surgery, Hospital Universitario Marqués de Valdecilla (HUMV), Santander, Spain.
General Surgery, Hospital Universitario Marqués de Valdecilla (HUMV), Santander, Spain.
Cir Esp (Engl Ed). 2024 Jun;102(6):322-330. doi: 10.1016/j.cireng.2024.02.010. Epub 2024 Mar 18.
Because of the obesity epidemic, more obese patients are on liver transplant (LT) waiting lists. The diseases associated with obesity may increase complications and limit survival after LT. However, there is no established measure or cut-off point to determine this impact and aid decision making. The aim of the present study is to evaluate obesity in patients undergoing LT via BMI and CT-based measurement of adipose tissue (AAT). These parameters will be used to predict the risk of postoperative complications and 5-year survival.
A retrospective, single-center study was carried out at a tertiary Spanish hospital, including all patients who received LT between January 2012 and July 2019 (n = 164). The patients were adults who underwent LT using the 'piggyback' technique, preserving the recipient vena cava. Visceral adipose tissue (VAT) and BMI were calculated to examine correlations with postoperative complications and 5-year survival.
No significant association was found between postoperative complications by Comprehensive Complication Index, BMI, AAT/height, subcutaneous fat/height and VAT/height. Kaplan-Meier curves for 5-year survival compared LT recipients with BMI < 30.45 versus ≥30.45, with an estimated survival of 58.97 months versus 43.11 months, respectively (P < .001) (Fig. 3) and for LT recipients with an AAT/height <27.35 mm versus ≥27.35 mm, with an estimated survival of 57.69 months versus 46.34 months (P = .001).
This study does not show a higher rate of postoperative complications in obese patients. There is a significantly lower long-term survival in patients with AAT/height ≥27.35 mm and BMI ≥ 30.45. BMI is a valid estimate of obesity and is predictive of survival.
由于肥胖症的流行，越来越多的肥胖患者进入肝移植（LT）等待名单。与肥胖相关的疾病可能会增加并发症的发生，并限制肝移植后的生存率。然而，目前尚无既定的衡量标准或临界点来确定这种影响并辅助决策。本研究的目的是通过体重指数（BMI）和基于计算机断层扫描（CT）的脂肪组织测量（AAT）来评估接受肝移植患者的肥胖情况。这些参数将用于预测术后并发症的风险和5年生存率。
在一家西班牙三级医院进行了一项回顾性单中心研究，纳入了2012年1月至2019年7月期间接受肝移植的所有患者（n = 164）。患者均为成年人，采用“背驮式”技术进行肝移植，保留受体腔静脉。计算内脏脂肪组织（VAT）和BMI，以检验其与术后并发症和5年生存率的相关性。
综合并发症指数、BMI、AAT/身高、皮下脂肪/身高和VAT/身高与术后并发症之间未发现显著关联。5年生存率的Kaplan-Meier曲线比较了BMI < 30.45与≥30.45的肝移植受者，估计生存率分别为58.97个月和43.11个月（P < .001）（图3），以及AAT/身高 < 27.35 mm与≥27.35 mm的肝移植受者，估计生存率分别为57.69个月和46.34个月（P = .001）。
本研究未显示肥胖患者术后并发症发生率更高。AAT/身高≥27.35 mm且BMI≥30.45的患者长期生存率显著较低。BMI是肥胖的有效估计指标，可预测生存率。
