Kidney transplantation in obese patients.
Kidney transplantation in obese patients.
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DOI：
10.5500/wjt.v6.i1.135
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发表时间：
2016-03-24
期刊：
影响因子：
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通讯作者：
Ichii, Hirohito
中科院分区：
文献类型：
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作者：
Tran, Minh-Ha;Foster, Clarence E;Ichii, Hirohito
世界卫生组织估计，2014年，超过6亿人符合肥胖标准。2011年，超过30%接受肾移植的个体的体重指数（BMI）为35 kg/m2或更高。最近的一些研究已经证实了超重/肥胖与肾移植患者的重要合并症之间的关系。与非移植手术一样，移植后伤口和软组织并发症的发生率增加，移植物功能延迟的发生率也增加。与正常BMI相比，这两个问题似乎有助于更长的住院时间。在肥胖人群中，移植后新发糖尿病和心脏结局似乎也有所增加。肥胖对肾移植后患者生存率的影响仍有争议，但似乎反映了非移植人群中BMI极端的影响。（开放式和腹腔镜）Roux-en-Y胃旁路术和腹腔镜袖状胃切除术的早期经验支持极好的体重减轻（1年时体重减轻50%-60%），但专家建议需要进一步研究。长期营养缺乏仍然是一个问题，但一般来说，这些程序似乎不会对免疫抑制药物的吸收产生不利影响。在这项研究中，我们回顾了文献，以更好地了解肥胖患者肾移植的相关风险。
The World Health Organization estimated that in 2014, over 600 million people met criteria for obesity. In 2011, over 30% of individuals undergoing kidney transplant had a body mass index (BMI) 35 kg/m(2) or greater. A number of recent studies have confirmed the relationship between overweight/obesity and important comorbidities in kidney transplant patients. As with non-transplant surgeries, the rate of wound and soft tissue complications are increased following transplant as is the incidence of delayed graft function. These two issues appear to contribute to longer length of stay compared to normal BMI. New onset diabetes after transplant and cardiac outcomes also appear to be increased in the obese population. The impact of obesity on patient survival after kidney transplantation remains controversial, but appears to mirror the impact of extremes of BMI in non-transplant populations. Early experience with (open and laparoscopic) Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy support excellent weight loss (in the range of 50%-60% excess weight lost at 1 year), but experts have recommended the need for further studies. Long term nutrient deficiencies remain a concern but in general, these procedures do not appear to adversely impact absorption of immunosuppressive medications. In this study, we review the literature to arrive at a better understanding of the risks related to renal transplantation among individuals with obesity.