Body mass index, weight-adjusted immunosuppression and the risk of acute rejection and infection after kidney transplantation: a cohort study
Body mass index, weight-adjusted immunosuppression and the risk of acute rejection and infection after kidney transplantation: a cohort study
复制标题
DOI：
10.1093/ndt/gfz095
复制
发表时间：
2019-12-01
影响因子：
6.1
通讯作者：
Clayton, Philip
中科院分区：
文献类型：
--
作者：
Flabouris, Katerina;Chadban, Steven;Clayton, Philip
背景。身体质量指数（BMI）与肾移植后患者的预后相关。我们假设免疫抑制（IS）剂量是一个促成因素。使用澳大利亚和新西兰的透析和移植登记数据，我们纳入了2000- 2014年期间接受强的松龙、霉酚酸盐和他克莫司/环孢素治疗的所有成人仅肾移植受者（n = 7919）。暴露是BMI，结果是时间：(i)急性排斥反应，（ii）致命感染，（iii）癌症和（iv）移植；(v)患者生存。在扩展的Cox模型中，我们将BMI和IS剂量（以四分位数为单位）建模为时变协变量。与BMI为25 kg/m(2)的患者相比，在调整人口统计学和合并症后，BMI为35的患者与急性排斥反应相关[校正风险比(aHR) = 1.29, 95%可信区间（CI） 1.12-1.49]。校正IS后，这种关联几乎消失（aHR = 1.09, 95% CI 0.93-1.29）。BMI为35与致命感染的减少无显著相关性（aHR = 0.91, 95% CI 0.66-1.25），但在调整IS后，情况发生逆转（aHR = 1.54, 95% CI 1.03-2.28）。在调整IS后，癌症的结果没有明显改变。同样，较低BMI的结果没有显著改变，尽管通常与较差的结果相关。我们的研究结果表明，在校正IS后，高BMI、急性排斥反应和肾移植后致死性感染之间的关联显著改变，这表明肥胖患者的相对剂量不足可能部分解释了这些关联。
Background. Body mass index (BMI) is associated with patient outcomes after kidney transplantation. We hypothesized that immunosuppression (IS) dosing is a contributing factor.Methods. Using Australia and New Zealand Dialysis and Transplant registry data, we included all adult kidney-only transplant recipients over 2000-14 treated with prednisolone, mycophenolate and tacrolimus/cyclosporin (n = 7919). The exposure was BMI and the outcomes were time to: (i) acute rejection, (ii) fatal infection, (iii) cancer and (iv) graft; and (v) patient survival. We modelled BMI and IS dosing (in quartiles) as time-varying covariates in extended Cox models.Results. Compared with a BMI of 25 kg/m(2), a BMI of 35 was associated with acute rejection after adjusting for demographics and comorbidities [adjusted hazard ratio (aHR) = 1.29, 95% confidence interval (CI) 1.12-1.49]. This association virtually disappeared after correcting for IS (aHR = 1.09, 95% CI 0.93-1.29). A BMI of 35 was non-significantly associated with fewer fatal infections (aHR = 0.91, 95% CI 0.66-1.25), but this reversed after adjusting for IS (aHR = 1.54, 95% CI 1.03-2.28). Results for cancer were not significantly altered after adjusting for IS. Results for lower BMI were similarly not significantly altered though generally associated with worse outcomes.Conclusions. Our findings show that the associations between high BMI, acute rejection and fatal infection after kidney transplantation were significantly altered after correcting for IS suggesting that relative under-dosing of obese patients may partially explain these associations.