Amr M T Alnagar, Shahab Hajibandeh, Shahin Hajibandeh, Abdul R Hakeem, Bobby V M Dasari
{"title":"肝移植后供体肥胖对移植物和受体存活结果的影响：系统回顾与元分析》。","authors":"Amr M T Alnagar, Shahab Hajibandeh, Shahin Hajibandeh, Abdul R Hakeem, Bobby V M Dasari","doi":"10.1097/TXD.0000000000001656","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The effect of donor body mass index (BMI) on liver transplantation (LT) outcomes remains unclear.</p><p><strong>Methods: </strong>A systematic search of the MEDLINE, CENTRAL, Web of Science, and bibliographic reference lists was conducted. All comparative studies evaluating the outcomes of LT in obese (BMI > 30 kg/m<sup>2</sup>) and nonobese donors (BMI < 30 kg/m<sup>2</sup>) were included, and their risk of bias was assessed using the ROBINS-I assessment tool. Patient and graft survival, acute rejection, and graft failure requiring retransplantation were evaluated as outcome parameters. A random-effects model was used for outcome synthesis.</p><p><strong>Results: </strong>We included 6 comparative studies reporting a total of 5071 liver transplant recipients from 708 obese and 4363 nonobese donors. There was no significant difference in 1-y (89.1% versus 84.0%, odds ratio [OR] 1.58; 95% CI 0.63-3.94, <i>P</i> = 0.33), 5-y (74.2%% versus 73.5%, OR 1.12; 95% CI 0.45-2.80, <i>P</i> = 0.81) graft survival, and 1-y (87.1% versus 90.3%, OR 0.71; 95% CI 0.43-1.15, <i>P</i> = 0.17) and 5-y (64.5% versus 71.6%, OR 0.71; 95% CI 0.49-1.05, <i>P</i> = 0.08) patient survival between 2 groups. Furthermore, recipients from obese and nonobese donors had a comparable risk of graft failure requiring retransplantation (OR 0.92; 95% CI 0.33-2.60, <i>P</i> = 0.88) or acute graft rejection (OR 0.70; 95% CI 0.45-1.11, <i>P</i> = 0.13).</p><p><strong>Conclusions: </strong>A meta-analysis of the best available evidence (level 2a) demonstrates that donor obesity does not seem to have a negative impact on graft or patient outcomes. The available studies might be subject to selection bias as the grafts from obese donors are usually subject to biopsy to exclude steatosis and the recipients usually belong to the low-risk group. Future research is needed to evaluate the impact of donors subgrouped by various higher BMI on graft and patient-related outcomes as well as to capture data of the discarded grafts from obese donors; hence, selection criteria for the grafts that could be used for transplantation from obese donors is identified.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 9","pages":"e1656"},"PeriodicalIF":1.9000,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365672/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of Donor Obesity on Graft and Recipient Survival Outcomes After Liver Transplantation: A Systematic Review and Meta-analysis.\",\"authors\":\"Amr M T Alnagar, Shahab Hajibandeh, Shahin Hajibandeh, Abdul R Hakeem, Bobby V M Dasari\",\"doi\":\"10.1097/TXD.0000000000001656\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The effect of donor body mass index (BMI) on liver transplantation (LT) outcomes remains unclear.</p><p><strong>Methods: </strong>A systematic search of the MEDLINE, CENTRAL, Web of Science, and bibliographic reference lists was conducted. All comparative studies evaluating the outcomes of LT in obese (BMI > 30 kg/m<sup>2</sup>) and nonobese donors (BMI < 30 kg/m<sup>2</sup>) were included, and their risk of bias was assessed using the ROBINS-I assessment tool. Patient and graft survival, acute rejection, and graft failure requiring retransplantation were evaluated as outcome parameters. A random-effects model was used for outcome synthesis.</p><p><strong>Results: </strong>We included 6 comparative studies reporting a total of 5071 liver transplant recipients from 708 obese and 4363 nonobese donors. There was no significant difference in 1-y (89.1% versus 84.0%, odds ratio [OR] 1.58; 95% CI 0.63-3.94, <i>P</i> = 0.33), 5-y (74.2%% versus 73.5%, OR 1.12; 95% CI 0.45-2.80, <i>P</i> = 0.81) graft survival, and 1-y (87.1% versus 90.3%, OR 0.71; 95% CI 0.43-1.15, <i>P</i> = 0.17) and 5-y (64.5% versus 71.6%, OR 0.71; 95% CI 0.49-1.05, <i>P</i> = 0.08) patient survival between 2 groups. Furthermore, recipients from obese and nonobese donors had a comparable risk of graft failure requiring retransplantation (OR 0.92; 95% CI 0.33-2.60, <i>P</i> = 0.88) or acute graft rejection (OR 0.70; 95% CI 0.45-1.11, <i>P</i> = 0.13).</p><p><strong>Conclusions: </strong>A meta-analysis of the best available evidence (level 2a) demonstrates that donor obesity does not seem to have a negative impact on graft or patient outcomes. The available studies might be subject to selection bias as the grafts from obese donors are usually subject to biopsy to exclude steatosis and the recipients usually belong to the low-risk group. Future research is needed to evaluate the impact of donors subgrouped by various higher BMI on graft and patient-related outcomes as well as to capture data of the discarded grafts from obese donors; hence, selection criteria for the grafts that could be used for transplantation from obese donors is identified.</p>\",\"PeriodicalId\":23225,\"journal\":{\"name\":\"Transplantation Direct\",\"volume\":\"10 9\",\"pages\":\"e1656\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-08-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365672/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Transplantation Direct\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/TXD.0000000000001656\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"TRANSPLANTATION\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation Direct","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/TXD.0000000000001656","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"TRANSPLANTATION","Score":null,"Total":0}
引用次数: 0
摘要
背景：供体体重指数（BMI）对肝移植结果的影响仍不清楚：供体体重指数（BMI）对肝移植（LT）结果的影响仍不清楚：方法：对 MEDLINE、CENTRAL、Web of Science 和参考文献目录进行了系统检索。纳入了所有评估肥胖（体重指数大于 30 kg/m2）和非肥胖供体（体重指数小于 30 kg/m2）LT 结局的对比研究，并使用 ROBINS-I 评估工具对其偏倚风险进行了评估。患者和移植物存活率、急性排斥反应和需要再次移植的移植物失败作为结果参数进行评估。结果综合采用了随机效应模型：我们纳入了 6 项比较研究，报告了 708 名肥胖和 4363 名非肥胖供体的 5071 名肝移植受者。1年（89.1%对84.0%，几率比[OR]1.58；95% CI 0.63-3.94，P = 0.33）、5年（74.2%对73.5%，OR 1.12；95% CI 0.45-2.80，P = 0.两组之间的移植物存活率、1年（87.1% 对 90.3%，OR 0.71；95% CI 0.43-1.15，P = 0.17）和 5 年（64.5% 对 71.6%，OR 0.71；95% CI 0.49-1.05，P = 0.08）患者存活率也存在差异。此外，肥胖捐献者和非肥胖捐献者的受者发生需要再次移植的移植物失败（OR 0.92；95% CI 0.33-2.60，P = 0.88）或急性移植物排斥反应（OR 0.70；95% CI 0.45-1.11，P = 0.13）的风险相当：对现有最佳证据（2a 级）的荟萃分析表明，供体肥胖似乎不会对移植物或患者预后产生负面影响。现有的研究可能存在选择偏差，因为肥胖供体的移植物通常需要进行活检以排除脂肪变性，而受体通常属于低风险组。未来的研究需要评估按不同较高体重指数分组的供体对移植物和患者相关预后的影响，并获取肥胖供体废弃移植物的数据；因此，需要确定可用于肥胖供体移植的移植物的选择标准。
Impact of Donor Obesity on Graft and Recipient Survival Outcomes After Liver Transplantation: A Systematic Review and Meta-analysis.
Background: The effect of donor body mass index (BMI) on liver transplantation (LT) outcomes remains unclear.
Methods: A systematic search of the MEDLINE, CENTRAL, Web of Science, and bibliographic reference lists was conducted. All comparative studies evaluating the outcomes of LT in obese (BMI > 30 kg/m2) and nonobese donors (BMI < 30 kg/m2) were included, and their risk of bias was assessed using the ROBINS-I assessment tool. Patient and graft survival, acute rejection, and graft failure requiring retransplantation were evaluated as outcome parameters. A random-effects model was used for outcome synthesis.
Results: We included 6 comparative studies reporting a total of 5071 liver transplant recipients from 708 obese and 4363 nonobese donors. There was no significant difference in 1-y (89.1% versus 84.0%, odds ratio [OR] 1.58; 95% CI 0.63-3.94, P = 0.33), 5-y (74.2%% versus 73.5%, OR 1.12; 95% CI 0.45-2.80, P = 0.81) graft survival, and 1-y (87.1% versus 90.3%, OR 0.71; 95% CI 0.43-1.15, P = 0.17) and 5-y (64.5% versus 71.6%, OR 0.71; 95% CI 0.49-1.05, P = 0.08) patient survival between 2 groups. Furthermore, recipients from obese and nonobese donors had a comparable risk of graft failure requiring retransplantation (OR 0.92; 95% CI 0.33-2.60, P = 0.88) or acute graft rejection (OR 0.70; 95% CI 0.45-1.11, P = 0.13).
Conclusions: A meta-analysis of the best available evidence (level 2a) demonstrates that donor obesity does not seem to have a negative impact on graft or patient outcomes. The available studies might be subject to selection bias as the grafts from obese donors are usually subject to biopsy to exclude steatosis and the recipients usually belong to the low-risk group. Future research is needed to evaluate the impact of donors subgrouped by various higher BMI on graft and patient-related outcomes as well as to capture data of the discarded grafts from obese donors; hence, selection criteria for the grafts that could be used for transplantation from obese donors is identified.
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