The temporal and long-term impact of donor body mass index on recipient outcomes after kidney transplantation - a retrospective study
The temporal and long-term impact of donor body mass index on recipient outcomes after kidney transplantation - a retrospective study
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DOI：
10.1111/tri.13505
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发表时间：
2020-01-01
影响因子：
3.1
通讯作者：
Schaubel, Douglas E.
中科院分区：
文献类型：
--
作者：
Naik, Abhijit S.;Zhong, Yingchao;Schaubel, Douglas E.
体重指数（BMI）的增加对慢性肾脏疾病的发生和进展的影响是确定的。即使是来自肥胖活体供体的植入肾活检也显示出细微的组织学变化，尽管功能正常。我们假设来自肥胖活体（LD）和死亡供体（DD）的肾脏移植的长期预后较差。在一项利用美国移植登记处的研究中，我们研究了2000年至2014年的成人肾移植受者。供体BMI为35 kg/m(2)（非常肥胖）。我们感兴趣的结果是死亡审查移植失败（DCGF）。分别对DD和LD肾受者拟合Cox比例风险模型，并根据供体、受体和移植特征（包括供体和受体大小错配比）进行调整。在118 734例DD和84 377例LD移植受者中，我们观察到超重（LD:HR = 1.06, DD:HR = 1.04）、轻度肥胖（LD:HR = 1.16, DD:HR = 1.10）和非常肥胖（LD:HR = 1.22, DD:HR = 1.22）的DCGF风险与正常BMI相比有显著的分级增加（P < 0.05）。供体BMI对预后的分级影响开始较早，并持续整个移植后时期。尽管对供体和受体大小不匹配以及其他供体、受体和移植因素进行了调整，供体肥胖状况仍是同种异体肾移植长期预后较差的独立危险因素。
The impact of increasing body mass index (BMI) on development and progression of chronic kidney disease is established. Even implantation kidney biopsies from obese living donors demonstrate subtle histologic changes despite normal function. We hypothesized that kidneys from obese living (LD) and deceased donors (DD) would have inferior long-term allograft outcomes. In a study utilizing US transplant registry, we studied adult kidney transplant recipients from 2000 to 2014. Donors were categorized as BMI 35 kg/m(2) (very obese). Our outcome of interest was death censored graft failure (DCGF). Cox proportional hazards model were fitted separately for recipients of DD and LD kidneys, and adjusted for donor, recipient, and transplant characteristics, including donor and recipient size mismatch ratio. Among 118 734 DD and 84 377 LD transplants recipients, we observed a significant and graded increase in DCGF risk among the overweight (LD:HR = 1.06, DD:HR = 1.04), mildly obese (LD:HR = 1.16, DD:HR = 1.10), and very obese (LD:HR = 1.22, DD:HR = 1.22) compared to normal BMI (P < 0.05). The graded effect of donor BMI on outcomes begins early and persists throughout the post-transplant period. Donor obesity status is an independent risk factor for inferior long-term renal allograft outcome despite adjusting for donor and recipient size mismatch and other donor, recipient, and transplant factors.