Mehmet Kanbay MD, Dimitrie Siriopol MD, Sama Mahmoud Abdel-Rahman MD, Zeynep Y. Yilmaz MD, Lasin Ozbek MD, Mustafa Guldan MD, Sidar Copur MD, Katherine R. Tuttle MD
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引用次数: 0
摘要
背景和目的：肾移植受者经常经历各种代谢并发症，包括体重变化，这显著影响患者预后和移植物功能，但体重增加与移植结果之间的关系尚不清楚。本系统综述和荟萃分析旨在综合有关肾移植后体重增加对患者和移植物预后影响的现有证据，以加强临床实践并优化移植后护理策略。材料和方法：通过PubMed和Scopus等数据库进行文献检索，检索截至2024年8月8日发表的同行评议研究。我们纳入了移植后体重显著增加且临床相关的成人肾移植受者（18岁及以上）和无此类变化的对照组，重点关注全因死亡率、移植物存活率、心血管事件和急性排斥反应等结果。结果：纳入11项研究数据的汇总分析显示，移植后体重增加与全因死亡风险之间无显著关联(风险比[HR] 1.21, 95%可信区间[CI] 0.69 ~ 2.10, p = 0.51；I2 = 28%)，心血管事件(HR 0.93, 95% CI 0.43 ~ 2.01, p = 0.85；I2 = 32%)或急性排斥反应(HR 1.13, 95% CI 0.76 ~ 1.68, p = 0.55；i2 = 9%)。然而，体重增加与移植物衰竭风险增加显著相关（HR 1.58, 95% CI 1.22 ~ 2.05, p 2 = 0%）。结论：肾移植后体重显著增加与移植失败的高风险相关。在研究观察的时间框架内，肾移植受者的全因死亡率、心血管事件或急性排斥反应的风险并未因体重增加而增加。
Impact of weight change on kidney transplantation outcomes: A systematic review and meta-analysis
Background and Aim
Kidney transplant recipients frequently experience a wide range of metabolic complications, including weight changes, which significantly impact patient outcomes and graft function, yet the relationship between weight gain and transplant outcomes remains poorly understood. This systematic review and meta-analysis aimed to synthesise existing evidence on the influence of weight gain on patient and graft outcomes following kidney transplantation to enhance clinical practice and optimise post-transplant care strategies.
Materials and Methods
A literature search was conducted across databases such as PubMed and Scopus for peer-reviewed studies published up to 8 August 2024. We included adult kidney transplant recipients (ages 18 years and older) with substantial and clinically relevant post-transplant weight gain and a control group without such changes, focusing on outcomes including all-cause mortality, graft survival, cardiovascular events and acute rejection.
Results
The pooled analysis, which included data from 11 studies, indicated no significant association between post-transplant weight gain and the risk of all-cause mortality (hazard ratio [HR] 1.21, 95% confidence interval [CI] 0.69 to 2.10, p = 0.51; I2 = 28%), cardiovascular events (HR 0.93, 95% CI 0.43 to 2.01, p = 0.85; I2 = 32%) or acute rejection (HR 1.13, 95% CI 0.76 to 1.68, p = 0.55; I2 = 9%). However, weight gain was significantly associated with an increased risk of graft failure (HR 1.58, 95% CI 1.22 to 2.05, p < 0.001; I2 = 0%).
Conclusion
Substantial and clinically relevant weight gain after kidney transplant was associated with a higher risk of graft failure. Within the timeframes of study observation, risks of all-cause mortality, cardiovascular events or acute rejection were not increased by weight gain in kidney transplant recipients.
期刊介绍：
Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.
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