Effect of Changes in Body Mass Index on Cardiovascular Outcomes in Kidney Transplant Recipients
Effect of Changes in Body Mass Index on Cardiovascular Outcomes in Kidney Transplant Recipients
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DOI：
10.1016/j.transproceed.2017.03.049
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发表时间：
2017-06-01
影响因子：
0.9
通讯作者：
Ahn, C.
中科院分区：
文献类型：
--
作者：
Kim, K. Y.;Cho, J. -H.;Ahn, C.
背景。肾移植（KT）前较高的体重指数（BMI）与肾移植受者（KTR）的死亡率和同种异体移植物丢失增加相关。然而，KT 后 BMI 的变化对这些结果的影响仍不确定。本研究的目的是调查基线 BMI 和 BMI 变化对 KTR 临床结果的影响。方法。 2012年至2015年，一项多中心观察性队列研究共招募了869名KTR。在KT之前，根据23 kg/m2的BMI临界点将患者分为低BMI组和高BMI组。分析了两组之间急性排斥反应和心血管疾病（CVD）的差异。此外，还比较了 4 个 BMI 组的临床结果除以 KT 后 1 年的 BMI 变化。还评估了 BMI 变化与实验室检查结果之间的关联。结果。与 BMI 较低的患者相比，KT 前 BMI 较高的患者在 KT 后的 CVD 显着增加 (P = .027)。然而，在基线 BMI 较高的 KTR 中，只有持续较高的 BMI 与随访期间 CVD 增加相关 (P = .003)。 BMI持续较高的患者高密度脂蛋白胆固醇显着降低，血红蛋白、甘油三酯和糖化血红蛋白水平升高。基线BMI和移植后BMI变化与KTR的急性排斥反应无关。结论。 KT 后第一年的 BMI 以及基线 BMI 与 KTR 中的 CVD 相关。需要对 KT 后 BMI 未降低的肥胖 KTR 进行更仔细的监测。
Background. A higher body mass index (BMI) before kidney transplantation (KT) is associated with increased mortality and allograft loss in kidney transplant recipients (KTRs). However, the effect of changes in BMI after KT on these outcomes remains uncertain. The aim of this study was to investigate the effect of baseline BMI and changes in BMI on clinical outcomes in KTRs.Methods. A total of 869 KTRs were enrolled from a multicenter observational cohort study from 2012 to 2015. Patients were divided into low and high BMI groups before KT based on a BMI cutoff point of 23 kg/m(2). Differences in acute rejection and cardiovascular disease (CVD) between the 2 groups were analyzed. In addition, clinical outcomes across the 4 BMI groups divided by BMI change 1 year after KT were compared. Associations between BMI change and laboratory findings were also evaluated.Results. Patients with a higher BMI before KT showed significantly increased CVD after KT (P = .027) compared with patients with a lower BMI. However, among the KTRs with a higher baseline BMI, only persistently higher BMI was associated with increased CVD during the follow-up period (P = .003). Patients with persistently higher BMI had significantly decreased high-density lipoprotein cholesterol and increased hemoglobin, triglyceride, and hemoglobin A1c levels. Baseline BMI and post-transplantation change in BMI were not related to acute rejection in KTRs.Conclusions. BMI in the 1st year after KT as well as baseline BMI were associated with CVD in KTRs. More careful monitoring of obese KTRs who do not undergo a reduction in BMI after KT is required.