肝移植在精心挑选的III类肥胖受者中产生良好的结果。

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2025-01-13 DOI:10.1111/ctr.70060

Kevin Yi, Vicki Avery, John McCall, Hannah Giles, Helen Lindsay, Ed Gane, David Orr, Louise Barbier

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引用次数: 0

摘要

先前的指南认为体重指数（BMI）超过40 kg/m2是肝移植（LT）的相对禁忌症。目的是检查I-III级肥胖患者的选择过程和研究结果。方法：回顾性分析2010年至2023年在本中心接受过LT评估的肥胖患者的结局，将其分为三类：I类（BMI30-34.9 kg/m2）、II类（BMI35-39.9 kg/m2）和III类（bmi35 - 40 kg/m2）。采用非肥胖成年患者的生存率进行比较。结果：315例BMI≥30 kg/m2的患者被评估为lt。17例（5.4%）因合并症而未列入等待名单。168例患者接受了移植：I类100例，II类43例，III类25例。术后并发症无差异(Clavien-Dindo 3级及以上；（I-III类肥胖分别为41%，42%,48%）或患者和移植物存活率（全队列5年生存率分别为84.4%和82.7%）。此外，非肥胖和肥胖患者的患者和移植物存活率无差异（p = 0.932）。结论：经过严格的筛选过程，III级肥胖患者术后短期预后与I-II级肥胖患者相当。肥胖和非肥胖患者的长期生存率相同。

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Liver Transplantation in Well-Selected Class III Obese Recipients Yields Good Outcomes

Introduction

Previous guidelines considered body mass index (BMI) over 40 kg/m² a relative contra-indication to liver transplantation (LT). The aims were to examine the selection process and study outcomes of patients with Class I–III obesity.

Methods

Retrospective analysis of outcomes of obese patients assessed for LT at our center between 2010 and 2023, divided into three groups: Class I (BMI30-34.9 kg/m²), Class II (BMI35-39.9 kg/m²), and Class III (BMI>40 kg/m²). Survival of non-obese adult patients was used for comparison.

Results

Three hundred fifteen patients with BMI ≥30 kg/m² were assessed for LT. Seventeen (5.4%) were not wait-listed due to comorbidities. One hundred sixty-eight patients were transplanted: 100 Class I, 43 Class II, and 25 Class III. There were no differences in postoperative complications (Clavien-Dindo Grade 3 or more; 41%, 42%, 48% for Class I–III obesity respectively) or patient and graft survival (5-y rates 84.4% and 82.7%, respectively, for the whole cohort) according to the different classes of obesity. Furthermore, patient and graft survival was not different between non-obese and obese patients (p = 0.932).

Conclusion

With a rigorous selection process, short-term outcomes after LT for patients with Class III obesity were comparable to patients with Class I–II obesity. Long-term survival was identical for obese and non-obese patients.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.