Parajuli Sandesh, Tamburrini Riccardo, Aziz Fahad, Dodin Ban, Astor Brad C, Mandelbrot Didier, Kaufman Dixon, Odorico Jon
Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; UW Health Transplant Center.
Transplant Direct. 2024 Oct 18;10(11):e1720. doi: 10.1097/TXD.0000000000001720. eCollection 2024 Nov.
There are limited data about the risk factors for weight changes and the association of significant weight changes with graft and metabolic outcomes after simultaneous pancreas and kidney (SPK) transplantation.
We included all SPK recipients with both allografts functioning for at least 6 mo post-transplant and categorized them based on the weight changes from baseline to 6 mo post-transplant. We analyzed risk factors for significant weight gain (SWG) and significant weight loss (SWL) over 6 mo post-transplant, as well as outcomes including pancreas uncensored graft failure, pancreas death-censored graft failure (DCGF), composite pancreas graft outcomes of DCGF, use of an antidiabetic agent, or hemoglobin A1C >6.5%, and kidney DCGF.
Of 280 SPK recipients, 153 (55%) experienced no significant weight change, 57 (20%) SWG, and 70 (25%) SWL. At 6 mo post-transplant, mean weight changes were 1.2% gain in the no significant weight change group, 13.4% gain in SWG, and 9.6% loss in the SWL groups. In multivariate analysis, the only factor associated with decreased risk for weight gain was older recipient age (aOR, 0.97; 95% confidence intervals, 0.95-0.99). Importantly, SWG or SWL were not associated with pancreas graft failure, P-DCGF, or K-DCGF. Interestingly in the adjusted model, SWG at 6 mo was associated with a lower risk for composite outcomes (HR, 0.35; 95% confidence intervals, 0.14-0.85).
Forty-five percent of SPK recipients had significant weight changes by 6 mo post-transplant, but only 20% exhibited SWG. Likely because of proper management, weight changes were not associated with poor outcomes post-SPK transplant.
关于同期胰肾联合移植（SPK）后体重变化的危险因素以及显著体重变化与移植物和代谢结局之间的关联，相关数据有限。
我们纳入了所有移植后同种异体移植物均至少功能良好6个月的SPK受者，并根据移植后6个月相对于基线的体重变化对他们进行分类。我们分析了移植后6个月内显著体重增加（SWG）和显著体重减轻（SWL）的危险因素，以及包括胰腺未删失移植物失败、胰腺死亡删失移植物失败（DCGF）、DCGF的复合胰腺移植物结局、使用抗糖尿病药物或糖化血红蛋白A1C>6.5%，以及肾脏DCGF等结局。
在280例SPK受者中，153例（55%）体重无显著变化，57例（20%）SWG，70例（25%）SWL。移植后6个月时，体重无显著变化组的平均体重增加1.2%，SWG组增加13.4%，SWL组减少9.6%。在多变量分析中，与体重增加风险降低相关的唯一因素是受者年龄较大（校正比值比，0.97；95%置信区间，0.95-0.99）。重要的是，SWG或SWL与胰腺移植物失败、P-DCGF或K-DCGF无关。有趣的是，在调整模型中，6个月时的SWG与复合结局风险较低相关（风险比，0.35；95%置信区间，0.14-0.85）。
45%的SPK受者在移植后6个月时体重有显著变化，但只有20%表现为SWG。可能由于管理得当，体重变化与SPK移植后的不良结局无关。
