肥胖真的会影响肾移植的结果吗?

L. Caamiña , A. Pietropaolo , G. Basile , M.İ. Dönmez , A. Uleri , A. Territo , P. Fraile
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摘要

肾移植是5期慢性肾病(CKD)患者的首选治疗方法。约60%的CKD患者在肾移植时超重或肥胖,50%的患者发生移植后肥胖,第一年体重增加10%,心血管死亡风险高。肥胖与移植物功能延迟(DGF)、急性排斥反应、手术并发症、移植物丢失和死亡率增加的风险相关。本研究的目的是评估接受肾移植的肥胖和超重患者的临床演变,基于与高BMI相关的短期和长期并发症。材料和方法:在2017年3月至2020年12月期间,对104例肾脏或胰肾移植患者进行了一项描述性、观察性、横断面研究,随访至2021年4月。为了进行对比分析,根据BMI对患者进行分组。结果:平均年龄56.65岁,男性占60.6%,女性占39.4%。超重患者手术时间延长,手术伤口裂开、移植物功能延迟、疝气、蛋白尿增多,肾活检适应症增多。此外,肥胖患者表现出更多的DGF、肾活检指征、蛋白尿、糖尿病的发展、心房颤动,需要延长住院时间。结论:尽管超重和/或肥胖人群中合并症的发生率很高,但我们发现患者和/或移植物的存活率没有降低。然而,需要更长的随访时间。
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Does obesity really affect renal transplantation outcomes?

Introduction

Kidney transplantation is the treatment of choice for patients with stage 5 chronic kidney disease (CKD). About 60% of CKD patients are overweight or obese at the time of kidney transplantation, and post-transplant obesity occurs in 50% of patients, with a weight gain of 10% in the first year and high risk of cardiovascular mortality. Obesity is associated with an increased risk of delayed graft function (DGF), acute rejection, surgical complications, graft loss and mortality. The aim of this study is to assess the clinical evolution of obese and overweight patients that have received a kidney transplant, based on short- and long-term complications associated with a higher BMI.

Material and methods

A descriptive, observational, cross-sectional study was conducted with 104 kidney or pancreas-kidney transplant patients between March 2017 and December 2020, with a follow-up until April 2021. For comparative analysis, patients were grouped according to BMI.

Results

Mean age was of 56.65 years, 60.6% male and 39.4 % female. Overweight patients experienced prolonged surgeries, more surgical wound dehiscence, delayed graft function, hernias, proteinuria and more indications for renal biopsies. Additionally, obese patients displayed more DGF, indications for renal biopsies, proteinuria, development of diabetes mellitus, atrial fibrillation and needed prolonged hospital stays.

Conclusions

Despite a high prevalence of comorbidity in the overweight and/or obese population, we found no reduction in patient and/or graft survival. However, longer follow-up is needed.

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