肥胖对心脏移植术后长期预后的影响。

IF 6.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Darae Kim, In-Cheol Kim, Jong-Chan Youn, Woo-Sung Chang, Jin-Jin Kim, Mi-Hyang Jung, Jin-Oh Choi, Daniel Seong Kyu Kim, Mason Lee, Evan P Kransdorf, David H Chang, Michelle M Kittleson, Jignesh K Patel, Fardad Esmailian, Jon A Kobashigawa
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引用次数: 0

摘要

背景:肥胖是一种持续的流行病,心脏移植(HTx)受者的体重指数(BMI)呈上升趋势是众所周知的。然而,肥胖患者htx治疗后的长期结果并没有明确的记录。目的:我们旨在研究肥胖患者移植后的长期预后。方法:在1990年9月至2022年6月期间连续招募的1,787名成人HTx受体患者中,患者被分为BMI组:体重过轻(结果:随着时间的推移,肥胖受体(BMI≥30 kg/m²)的数量显著增加,与体重正常的患者相比,肥胖受体更容易出现糖尿病和高血压等合并症,等待时间明显延长,并且更频繁地接受体型过轻的供体。在HTx治疗后6年的中位随访期间,肥胖患者的排异反应发生率明显高于正常体重患者(P= 0.027), HTx治疗后的生存率明显低于正常体重患者(P=0.009)。在多变量分析中,即使在调整相关临床变量后,肥胖患者移植后死亡率、原发性移植物功能障碍和任何治疗后排斥反应的风险也明显更高。结论:肥胖HTx受者表现出明显更高的死亡、原发性移植物功能障碍和任何治疗后排斥反应的风险。我们的研究结果强调了在HTx之前对肥胖进行前瞻性、多学科管理的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of Obesity on Long Term Post Heart Transplantation Outcomes.

Background: Obesity is an ongoing pandemic, and the rising trend of body mass index (BMI) in heart transplant (HTx) recipients is well known. However, the long term post-HTx outcomes of obese patients are not clearly documented.

Aims: We aimed to investigate long term post-transplant outcomes in obese patients.

Methods: Among 1,787 consecutively enrolled adult HTx recipients between September 1990 and June 2022, patients were categorized into BMI groups: underweight (<18 kg/m²), normal weight (18.0-24.9 kg/m²), overweight (25-29.9 kg/m²), and obese (≥ 30 kg/m²). The primary outcome was post-HTx mortality, with secondary outcomes including primary graft dysfunction, treated rejection, coronary allograft vasculopathy, retransplant, and nonfatal major adverse cardiac event.

Results: Over time, there was a significant increase in obese recipients (BMI ≥ 30 kg/m²) and they were more likely to have comorbidities such as diabetes and hypertension, experience significantly longer wait times, and more frequently received undersized donors compared to those with normal weight. During the median follow up duration of 6 years after HTx, obese recipients showed significantly higher incidence of treated rejection (P =0.027) and lower post-HTx survival compared to those with normal weight (P=0.009). In multivariable analysis, obese patients had a significantly higher risk of post-transplant mortality, primary graft dysfunction, and any treated rejection even after adjusting relevant clinical variables.

Conclusions: Obese HTx recipients demonstrated a significantly higher risk of death, primary graft dysfunction, and any treated rejection. Our findings highlight the need for proactive, multidisciplinary management of obesity prior to HTx.

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来源期刊
CiteScore
10.10
自引率
6.70%
发文量
1667
审稿时长
69 days
期刊介绍: The Journal of Heart and Lung Transplantation, the official publication of the International Society for Heart and Lung Transplantation, brings readers essential scholarly and timely information in the field of cardio-pulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.
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