Weight gain in long-term survivors of kidney or liver transplantation鈥擜nother paradigm of sarcopenic obesity?

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• 作者：Tatjana Schü ; tz ; Ph.D.^a ; Heike Hudjetz ; M.D.^b ; Anne-Eve Roske ; M.D.^b ; Cornelia Katzorke ; M.D.^b ; Georg Kreymann ; M.D.^c ; Klemens Budde ; M.D.^d ; Lutz Fritsche ; M.D.^d ; Hans-Hellmut Neumayer ; M.D.^d ; Herbert Lochs ; M.D.^b ; Mathias Plauth ; M.D.^b ; ^e ; ^{mathias.plauth@klinikum-dessau.de}
• 关键词：Anthropometry ; Bioimpedance analysis ; Chronic renal failure ; Hypermetabolism ; Indirect calorimetry ; Liver cirrhosis
• 刊名：Nutrition
• 出版年：2012
• 期刊代码：81_08999007
• 类别：abs
• 出版时间：April, 2012
• 卷：28
• 期：4
• 页码：378-383
• 文件大小：190 K

摘要

Objective

Obesity in transplant recipients is a frequent phenomenon but data from body composition analyses in long-term survivors are limited. Body composition and energy metabolism were studied in patients after liver (LTX) and kidney (KTX) transplantation and patients with liver cirrhosis (LCI) or on chronic hemodialysis (HD) and compared to healthy controls.

Methods

In 42 patients 50.0 mo (median; range 17.1-100.6) after LTX and 30 patients 93.0 mo (31.2-180.1) after KTX as wells as in LCI (n = 39) or HD (n = 10) patients mid-arm muscle and fat area, body cell mass, and phase angle (bioimpedance analysis), and resting energy expenditure (indirect calorimetry, REE_CALO) were measured.

Results

Obesity was more prevalent in LTX (17%) than LCI (3%) and in KTX (27%) than in HD (10%). In LTX and KTX, phase angle was higher than in end-stage disease (LTX 5.6掳 [4.1-7.2] versus LCI 4.4掳 [2.9-7.3], P < 0.001; KTX 5.9掳 [4.4-8.7] versus HD 4.3掳 [2.9-6.8]) but was lower in all patient groups than in controls (7.1掳; 4.6-8.9; P < 0.001). In LCI and HD REE_CALO was higher than predicted, while in LTX and KTX REE_CALO was not different from predicted REE.

Conclusions

Despite excellent graft function, many long-term LTX or KTX survivors exhibit a phenotype of sarcopenic obesity with increased fat but low muscle mass. This abnormal body composition is observed despite normalization of the hypermetabolism found in chronic disease and cannot be explained by overeating. The role of appropriate nutrition and physiotherapy after transplantation merits further investigation.