Abbasi Ali B, Posselt Andrew, Orandi Babak J, Odorico Jon S, Stock Peter G
Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, California.
Department of Surgery.
Curr Opin Organ Transplant. 2025 May 5. doi: 10.1097/MOT.0000000000001226.
We provide a review on the incidence, consequences, and management of obesity in patients before and after pancreas transplant.
Obesity is common in patients with both type 1 and type 2 diabetes. Obesity at the time of pancreas transplant is associated with worse graft and patient survival, while weight gain after transplant is associated with insulin resistance and posttransplant diabetes. Currently, lifestyle interventions are the backbone of obesity management and can improve insulin sensitivity, but result in only modest weight loss. Metabolic and bariatric surgery (MBS) offers the potential for substantial and durable weight loss. Laparoscopic sleeve gastrectomy is the procedure of choice and can be performed safely both before and after pancreas transplant. Antiobesity medications (AOMs) may also be effective, but concerns remain regarding determine the safety and efficacy when used in pancreas transplant recipients. More evidence is needed to guide the use of AOMs and MBS in pancreas transplant recipients.
Lifestyle interventions, MBS, and AOMs each have a role in managing obesity after pancreas transplantation. In light of limited evidence and unique challenges in pancreas transplant patients, obesity management in pancreas transplant patients requires an individualized approach that leverages multidisciplinary expertise.
我们对胰腺移植前后患者肥胖的发生率、后果及管理进行综述。
肥胖在1型和2型糖尿病患者中均很常见。胰腺移植时肥胖与移植物及患者生存率较差相关，而移植后体重增加与胰岛素抵抗及移植后糖尿病相关。目前，生活方式干预是肥胖管理的基础，可改善胰岛素敏感性，但仅导致适度体重减轻。代谢和减重手术（MBS）具有实现显著且持久体重减轻的潜力。腹腔镜袖状胃切除术是首选术式，可以在胰腺移植前后安全地进行。抗肥胖药物（AOMs）可能也有效，但在胰腺移植受者中使用时确定其安全性和有效性仍存在担忧。需要更多证据来指导在胰腺移植受者中使用AOMs和MBS。
生活方式干预、MBS和AOMs在胰腺移植后肥胖管理中均有作用。鉴于胰腺移植患者证据有限且面临独特挑战，胰腺移植患者的肥胖管理需要一种利用多学科专业知识的个体化方法。
