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【medical-news】肥胖的肾移植病人第一年的死亡率
Obese kidney transplant patients twice as likely to die in the first year or suffer organ failure
Survival and successful kidney transplant rates are significantly lower when people are obese, according to a study of over 2,000 patients published in the November issue of Transplant International.
A team of experts from across the Netherlands studied the medical profiles of 4,245 adults who had received kidney transplants, using data from the Netherlands Organ Transplantation Registry.
In 2067 cases there was sufficient information to calculate their Body Mass Index (BMI) ?based on their weight and height - at the time of their kidney transplant.
They discovered that six per cent of patients with a BMI of more than 30 died in the first year after transplant, compared with three per cent of patients with a BMI of less than 30.
By year five, the difference was even greater, with an 81 per cent survival rate for the obese patients and an 89 per cent survival rate for patients who were not obese.
The same pattern emerged when they looked at the success of the transplant itself.
A year after the transplant was carried out, 14 per cent of obese patients had experienced a transplant failure, compared with eight per cent of non obese patients.
After five years, 71 per cent of obese patients still had a successfully transplanted kidney, compared with 80 per cent of the patients with a lower BMI.
Obese patients were more likely suffer transplant failure through infection or permanent non-functioning, but the numbers for obese and non-obese patients were both fairly low.
There were no significant differences between the two groups when it came to why patients died, but there was a trend for obese patients to suffer more infections and fatal heart conditions.
Obese patients in the study group also tended to be older and were more likely to be female
"The prevalence of obesity in patients with end-stage renal disease is increasingly rapidly" says lead researcher Dr Jeroen Aalten from the Department of Nephrology at the University Medical Center in Nijmegen.
"It's estimated that 60 per cent of renal transplant candidates in the United States and 10 per cent in the Netherlands are obese or overweight.
"These figures have been rising consistently in recent years. This could be due to a general rise in obesity worldwide, but we can't rule out that it may have been affected by changes in inclusion criteria for kidney transplants."
The study ?which was carried out by Nephrology specialists from seven university hospitals across the Netherlands ?concluded that there is a significant relationship between obesity and increased transplant failure or death.
The authors acknowledge that there has been considerable debate about whether obese patients are suitable transplant candidates.
But they also point out that while obesity is preventable and fundamentally curable, compared to age and diabetes, experience shows that it can be very difficult for people with end-stage renal disease to lose weight.
"Our conclusion is that it's not fair to deny obese patients the chance of a kidney transplant as they still do better after a transplant than on dialysis" says Dr Aalten.
"However we shouldn't disregard the increased risk for obese patients after transplantation and we also need to bear in mind that it is important to give scarce resources to patients with the lowest risk.
"It is very important that patients facing kidney transplant are fully informed about the risks that they face and are encouraged to lose weight wherever possible." 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 肥胖的肾移植患者第一年的死亡率或器官衰竭率是正常的两倍
根据一项发表在十一月份国际移植杂志对2000多位患者的研究，肥胖患者的生存率和肾移植成功率显明显较低。
一个来自整个荷兰的专家组研究了4245名接受肾移植的成年患者的病历资料，所有数据来自荷兰器官移植登记处。
其中2067例有充足的资料以基于他们的体重和身高来计算在他们做肾移植时的体重指数（BMI）。
他们发现6%的BMI大于30的患者在移植后第一年死亡，相比之下BMI小于30的患者只有3%。
在第5年，差距甚至更大，肥胖患者的生存率为81%，而不肥胖的患者生存率为89%。
当他们着眼移植手术本身的成功率时，同样的情况出现了。
在移植后的一年中，14%的肥胖患者移植失败，与之相比的是8%的非肥胖患者。
5年以后，71%的肥胖患者保持正常的移植肾，与之相比，BMI较低的患者为80%。
肥胖患者移植肾由于感染或持久性失功能而衰竭的可能性更大，但肥胖和非肥胖的患者的数量都相当少。
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作者:admin@医学,生命科学 2010-10-15 05:11
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