减肥手术作为肾移植的桥梁。年龄与bmi配对分析。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-04-30 DOI:10.1016/j.transproceed.2025.03.003

Mohamed H. Zahran , Talal Khewater , Mostafa Ayyad , Ahmed Ali , Mojahid Ghazi , Ahmed Serageldeen , Alaaelden Omar , Zayed S. Aljohni , Waad Albalawi , Konstantinos Fourtounas , Hussam Adi

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引用次数: 0

摘要

背景：病态肥胖是肾移植（RT）的相对禁忌症，与围手术期并发症增加和移植物存活率降低有关。我们旨在评估终末期肾脏疾病（ESRD）患者减肥手术（BS）的安全性及其改善RT治疗的有效性，并将RT治疗结果与年龄和体重指数（BMI）匹配的组进行比较。方法：这是一项病例对照研究，包括8例ESRD患者，他们在RT之前接受了BS作为桥梁（组I）。主要结局是评估BS的安全性和有效性。次要结果是评估对RT结果、手术并发症和长期移植物存活的影响。第三个结果是将他们与年龄和bmi匹配的对照组（II组，16例患者）进行比较。结果：I组中位（IQR） BMI从41（38-45）降至31 (28-33)kg/m2 (P = 0.01)， BS后绝对百分比下降24%。7例糖尿病患者中有5例（71%）停止胰岛素治疗（P = .03）。所有高血压患者均减少了单药治疗（P = 0.03）。5例患者（63%）在25（5-45）个月后接受了放疗。所有患者出院时均带功能正常的移植物，血清肌酐中位数为81 (60-90)mmol/L，肾小球滤过率（eGFR）估计为79 (61-91)mL/min/1.73m2。1例（20%）因伤口感染再次手术。随访31（8-62）个月后，所有患者的移植物功能正常。两组术后并发症及出院时和末次随访时移植物功能比较，差异均无统计学意义（P < 0.05）。结论：对于移植前肥胖患者，BS是安全有效的，并且与没有BS病史的患者相关的RT结果相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Bariatric Surgery as a Bridge for Renal Transplantation. An Age and BMI-Matched Pair Analysis

Background

Morbid obesity is a relative contraindication for renal transplantation (RT) and associated with increased perioperative complications and compromised graft survival. We aimed at evaluating the safety of bariatric surgery (BS) in patients with end-stage renal disease (ESRD) and its efficacy on improving access to RT and to compare RT outcomes to an age- and body mass index (BMI)-matched group.

Methods

This is a case-control study including eight patients with ESRD who underwent BS as a bridge before RT (group I). The primary outcome was to assess the safety and efficacy of BS. The secondary outcome was to assess the impact on RT outcomes, surgical complications, and long-term graft survival. The third outcome was to compare them to an age- and BMI-matched control group (group II, 16 patients).

Results

In group I, the median (IQR) BMI decreased from 41 (38-45) to 31 (28-33) kg/m² (P = .01) with absolute percent reduction of 24% after BS. Five out of seven patients with diabetes (71%) stopped taking insulin medication (P = .03). All patients with hypertension decreased their medications to a single drug (P = 0.03). Five patients (63%) underwent RT after 25 (5-45) months. All were discharged with functioning grafts with median serum creatinine of 81 (60-90) mmol/L and estimated glomerular filtration rate (eGFR) of 79 (61-91) mL/min/1.73m². One patient (20%) was reoperated for wound infection. After follow-up of 31 (8-62) months, all patients have a functioning graft. No statistically significant differences were identified between both groups in regard to post-operative complications and graft function at discharge and at the last follow-up (P > .05).

Conclusions

BS is safe and effective in pre-transplant patients with obesity and associated with comparable RT outcomes to those without a history of BS.

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.