Lorden Heather, Engelken Jessa, Sprang Katrina, Rolfson Megan, Mandelbrot Didier, Parajuli Sandesh
Division of Transplantation, Department of Clinical Nutrition, UW Health Hospital and Clinics, Madison, WI.
Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Transplant Direct. 2024 Apr 26;10(5):e1619. doi: 10.1097/TXD.0000000000001619. eCollection 2024 May.
Kidney transplant centers lack consistent diagnostic malnutrition tools. The Academy of Nutrition and Dietetics and American Society of Parenteral Nutrition Adult Malnutrition Criteria (AMC) is the widely accepted and utilized tool by Registered Dietitian Nutritionists (RDNs) to diagnose malnutrition.
In this single-center, retrospective observational study, we evaluated the outcomes of prekidney transplant malnutrition based on Academy of Nutrition and Dietetics and American Society of Parenteral Nutrition AMC, as well as the individual components of the AMC, on posttransplant outcomes including length of stay, delayed graft function (DGF), early readmission, cardiovascular events, acute rejection, death-censored graft failure, and death. Bivariable and multivariable logistic regression models were used to assess the association of malnutrition or its components with outcomes of interest.
A total of 367 recipients were included, of whom 36 (10%) were malnourished (23 moderately and 13 severely) at pretransplant evaluation. In adjusted models, pretransplant malnutrition was significantly associated with increased risk for early readmission (adjusted odds ratio 2.86; 95% confidence interval: 1.14-7.21; = 0.03) and with DGF (adjusted odds ratio 8.33; 95% confidence interval: 1.07-64.6; = 0.04). Muscle depletion was also associated with an increased risk for readmission and with DGF. Fat depletion and reduced functionality in the adjusted model were only associated with increased risk for readmission.
Malnutrition could be an important consideration for selecting kidney transplant recipients because it was associated with poor clinical outcomes. A multidisciplinary approach with the involvement of RDNs to outline a nutrition intervention plan may help mitigate some of the poor outcomes.
肾移植中心缺乏一致的诊断营养不良的工具。营养与饮食学会及美国肠外营养学会成人营养不良标准（AMC）是注册营养师广泛接受和使用的诊断营养不良的工具。
在这项单中心回顾性观察研究中，我们基于营养与饮食学会及美国肠外营养学会AMC以及AMC的各个组成部分，评估肾移植术前营养不良对术后结局的影响，这些结局包括住院时间、移植肾功能延迟恢复（DGF）、早期再入院、心血管事件、急性排斥反应、死亡审查的移植失败及死亡。采用双变量和多变量逻辑回归模型评估营养不良或其组成部分与感兴趣结局之间的关联。
共纳入367名受者，其中36名（10%）在移植前评估时存在营养不良（23名中度营养不良，13名重度营养不良）。在调整模型中，移植前营养不良与早期再入院风险增加显著相关（调整优势比2.86；95%置信区间：1.14 - 7.21；P = 0.03），与移植肾功能延迟恢复也显著相关（调整优势比8.33；95%置信区间：1.07 - 64.6；P = 0.04）。肌肉消耗也与再入院风险增加及移植肾功能延迟恢复相关。在调整模型中，脂肪消耗和功能下降仅与再入院风险增加相关。
营养不良可能是选择肾移植受者时的一个重要考虑因素，因为它与不良临床结局相关。由注册营养师参与制定营养干预计划的多学科方法可能有助于减轻一些不良结局。
