Effects of Obesity on Postoperative Complications and Graft Survival After Kidney Transplantation
Effects of Obesity on Postoperative Complications and Graft Survival After Kidney Transplantation
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DOI：
10.1016/j.transproceed.2020.02.178
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发表时间：
2020-12-01
影响因子：
0.9
通讯作者：
Kleinclauss, Francois
中科院分区：
文献类型：
--
作者：
Fellmann, Marie;Balssa, Loic;Kleinclauss, Francois
目标。本研究的目的是分析肥胖对肾移植术后并发症及患者和移植物存活的影响。我们回顾了11年来在我们中心接受肾移植的506名患者。根据世界卫生组织的标准，肥胖的定义是体重指数=30公斤/米(2)。使用单变量和多变量分析，我们评估了肥胖对手术并发症的影响，根据Clavien-Dindo分类，直到术后30天。使用COX比例回归模型评估肥胖对移植物和患者存活的影响。71例患者肥胖(14%)，平均随访63.1个月(59.7-66.5)。通过多变量分析，肥胖与移植肾功能延迟有关(风险比[HR]=2.60[1.31-5.02]，P=0.004)。肥胖与手术并发症无关，但心血管病史与手术并发症相关(HR=1.68[1.09-2.99]，P=0.048)。经Cox回归分析，肥胖与移植物丢失风险显著相关(HR=1.55[1.06~2.99]，P=0.042)，但与患者存活率无关(HR=1.82[0.88~3.79]，P=.106)。肥胖与移植物功能延迟和移植物丢失有关。然而，它与手术并发症无关。肾移植仍然是患有终末期肾脏疾病的肥胖患者的最佳治疗方法，尽管移植肾存活时间较短。
Objective. The objective of this study was to analyze the effects of obesity on post-operative complications and patient and graft survival after kidney transplantation.Methods. We retrospectively included 506 patients who received a kidney transplant in our center during eleven years. Obesity was defined by a body mass index >= 30 kg/m(2) based on World Health Organization criteria. Using univariate and multivariate analyses, we evaluated the impact of obesity on surgical complications according to the Clavien-Dindo classification up to 30 days after surgery. The impact of obesity on graft and patient survival was assessed using a Cox proportional regression model.Results. Seventy-one patients were obese (14%), and mean follow-up was 63.1 months (59.7-66.5). By multivariable analysis, obesity was associated with delayed graft function (hazard ratio [HR] = 2.60 [1.31-5.02], P = .004). Obesity was not associated with surgical complications, but cardiovascular history was (HR = 1.68 [1.09-2.99], P = .048). By Cox regression analysis, obesity was significantly associated with a higher risk of graft loss (HR = 1.55 [1.06-2.99], P = .042) but not with patient survival (HR = 1.82 [0.88-3.79], P = .106).Conclusion. Obesity was associated with delayed graft function and graft loss. However, it was not associated with surgical complications. Kidney transplantation remains the best therapy for obese patients suffering from end-stage renal disease, despite shorter graft survival.