Gibt es einen Zusammenhang zwischen Adipositas und Adhärenz für Immunsuppressiva bei Patienten nach Nierentransplantation?

Ö. Albayrak; S. Pabst; M. Nöhre; A. Bertram; M. Schiffer; M. de Zwaan

doi:10.1055/s-0038-1624222

Adipositas - Ursachen, Folgeerkrankungen, Therapie, Table of Contents

Adipositas - Ursachen, Folgeerkrankungen, Therapie 2017; 11(04): 187-191
DOI: 10.1055/s-0038-1624222

Originalarbeit

Schattauer GmbH

Gibt es einen Zusammenhang zwischen Adipositas und Adhärenz für Immunsuppressiva bei Patienten nach Nierentransplantation?

Is there a relation between obesity and adherence to immunosuppressants in patients after renal transplantation?

Authors

Ö. Albayrak

¹Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover
S. Pabst

¹Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover

²Klinik für Nierenund Hochdruckerkrankungen, Medizinische Hochschule Hannover
M. Nöhre

¹Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover
A. Bertram

²Klinik für Nierenund Hochdruckerkrankungen, Medizinische Hochschule Hannover
M. Schiffer

²Klinik für Nierenund Hochdruckerkrankungen, Medizinische Hochschule Hannover
M. de Zwaan

¹Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover

Abstract

Zusammenfassung

Die Entwicklung von Adipositas nach einer Organtransplantation erhöht das Risiko für Komplikationen bis hin zum Transplantatverlust. In einer Querschnittsuntersuchung mit 241 nierentransplantierten Patienten wurde der Zusammenhang zwischen Adipositas und verschiedenen Maßen zur Bestimmung der Adhärenz mit Immunsuppressiva (IS) (Selbstbericht, Arzteinschätzung, Biopsie-gestützte Rejektionen, Variationskoeffizient der IS-Talspiegel) untersucht. Zum Zeitpunkt der Transplantation waren 12,9% (n=31) der Patienten adipös und zum Nachuntersuchungszeitpunkt (im Durchschnitt nach 7,2 Jahren) waren 23,7% (n=57) adipös (BM ≥ 30 kg/m²). Wir konnten keinen Unterschied zwischen adipösen und nicht adipösen Patienten in der selbst-beurteilten Adhärenz, der Adhärenzeinschätzung durch die betreuenden Ärzte und dem Vorliegen einer Biopsie-gestützten Rejektion während der letzten 12 Monate finden. Adipöse Patienten wiesen allerdings eine höhere Serumvariabilität der IS-Talspiegel auf im Vergleich zu nicht-adipösen Patienten (p=0,03). Die Serumvariabilität ist allerdings kein reines Adhärenzmaß. Insgesamt gibt es keine überzeugenden Hinweise darauf, dass Adipositas die IS Adhärenz bei Patienten nach Nierentransplantation negativ beeinflusst.

Summary

Post-transplant obesity significantly increases the risk for severe transplant dysfunction. In a cross-sectional study in n=241 renal transplant recipients, we investigated the relation between obesity and different measures of adherence to immunosuppressants (IS) including self-reported adherence, physicians´ estimation of adherence, biopsyproven rejection, and coefficient of variation of IS-trough levels. In a cross-sectional study 241 kidney transplant recipients who were at least 1 year post-transplant (mean 7.2 years) participated of whom 23.7% (n=57) were obese at the post-transplant time point( BMI ≥ 30 kg/m²) and 12.9% (n=31) were obese at the time of transplantation. No associations between obese and non-obese patients were found for self-rated adherence, physicians’ estimation of adherence, and the occurrence of acute biopsy-proven rejection episodes within the previous 12 months. The variability of IS-trough levels was significantly higher in obese compared to nonobese post-transplant patients (p=0.03). However, IS serum level variability cannot be seen as a pure measure of adherence. In summary, the study does not provide convincing evidence that obesity is associated with non-adherence to IS in patients after kidney transplantation.

Schlüsselwörter

Adipositas - Adhärenz - Immunsuppressiva - Nierentransplantation

Keywords

Obesity - adherence - immunosuppressants - kidney transplant

Full Text

References

Literatur
1 Ahmadi SF, Zahmatkesh G, Streja E, Molnar MZ, Rhee CM, Kovesdy CP, Gillen DL, Steiner S, Kalantar-Zadeh K. Body mass index and mortality in kidney transplant recipients: a systematic review and meta-analysis. Am J Nephrol 2014; 40: 315-324.
2 Beckmann S, Ivanović N, Drent G, Ruppar T, De Geest S. Weight gain, overweight and obesity in solid organ transplantation – a study protocol for a systematic literature review. Systematic Reviews 2015; 04: 2.
3 Borra LC, Roodnat JI, Kal JA, Mathot RA, Weimar W, van Gelder T. High within-patient variability in the clearance of tacrolimus is a risk factor for poor long-term outcome after kidney transplantation. Nephrol Dial Transplant 2010; 25: 2757-2763.
4 Chan W, Bosch JA, Jones D, McTernan PG, Phillips AC, Borrows R. Obesity in kidney transplantation. J Ren Nutr 2014; 24: 1-12.
5 De Geest S, Abraham I, Dunbar-Jacob J. Measuring transplant patients’ compliance with immunosuppressive therapy. West J Nurs Res 1996; 18: 595-605.
6 Dew MA, DiMartini AF, De Vito ADabbs, Myaskovsky L, Steel J, Unruh M, Switzer GE, Zomak R, Kormos RL, Greenhouse JB. Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation. Transplantation 2007; 83: 858-873.
7 Dew MA, Kormos RL, Roth LH, Murali S, DiMartini A, Griffith BP. Early post-transplant medical compliance and mental health predict physical morbidity and mortality one to three years after heart transplantation. J Heart Lung Transplant 1999; 18: 549-562.
8 Dziodzio T, Biebl M, Öllinger R, Pratschke J, Denecke C. The Role of Bariatric Surgery in Abdominal Organ Transplantation-the Next Big Challenge?. Obes Surg. 2017 doi: 10.1007/s11695–017–2854–8..
9 Fritz CO, Morris PE, Richler JJ. Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen 2012; 141: 2-18.
10 Goodall DL, Willicombe M, McLean AG, Taube D. High Intrapatient Variability of Tacrolimus Levels and Outpatient Clinic Nonattendance Are Associated With Inferior Outcomes in Renal Transplant Patients. Transplant Direct 2017; 03: e192.
11 Gutiérrez-Bedmar M, Villalobos EMartínez, García-Rodríguez A, Muñoz-Bravo C, Mariscal A. Psychiatric status across body mass index in a mediterranean Spanish population. PLoS One 2015; 10: e0145414.
12 Hill CJ, Courtney AE, Cardwell CR, Maxwell AP, Lucarelli G, Veroux M, Furriel F, Cannon RM, Hoogeveen EK, Doshi M, McCaughan JA. Recipient obesity and outcomes after kidney transplantation: a systematic review and meta-analysis. Nephrol Dial Transplant 2015; 30: 1403-1411.
13 Hoogeveen EK, Aalten J, Rothman KJ, Roodnat JI, Mallat MJ, Borm G, Weimar W, Hoitsma AJ, de Fijter JW. Effect of obesity on the outcome of kidney transplantation: a 20-year follow-up. Transplantation 2011; 91: 869-874.
14 Khalkhali HR, Ghafari A, Hajizadeh E, Kazemnejad A. Risk factors of long-term graft loss in renal transplant recipients with chronic allograft dysfunction. Exp Clin Transplant 2010; 08: 277-282.
15 Klaghofer R, Sarac N, Schwegler K, Schleuniger M, Noll G, Muellhaupt B, Ambuehl P, Boehler A, Irani S, Buddeberg C, Goetzmann L. [Questionnaire on emotional response after organ transplantation: German validation of the Transplant Effect Questionnaire (TxEQ-D)]. Z Psychosom Med Psychother 2008; 54: 174-188.
16 Kugler C, Einhorn I, Gottlieb J, Warnecke G, Schwarz A, Barg-Hock H, Bara C, Haller H, Haverich A. Postoperative weight gain during the first year after kidney, liver, heart, and lung transplant: a prospective study. Prog Transplant 2015; 25: 49-55.
17 Lafranca JA, IJermans JNM, Betjes MGH, Frank FJMFJMF Dor. Body mass index and outcome in renal transplant recipients: a systematic review and meta-analysis. BMC Medicine 2015; 13: 111.
18 Massey EK, Tielen M, Laging M. et al. Discrepancies between beliefs and behavior: a prospective study into immunosuppressive medication adherence after kidney transplantation. Transplantation 2015; 99: 375-380.
19 Massey EK, Tielen M, Laging M. et al. The role of goal cognitions, illness perceptions and treatment beliefs in self-reported adherence after kidney transplantation: a cohort study. J Psychosom Res 2013; 75: 229-234.
20 Mensink GB, Schienkiewitz A, Haftenberger M, Lampert T, Ziese T, Scheidt-Nave C. Overweight and obesity in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56: 786-794.
21 Nicoletto BB, Fonseca NK, Manfro RC, Goncalves LF, Leitao CB, Souza GC. Effects of obesity on kidney transplantation outcomes: a systematic review and meta-analysis. Transplantation 2014; 98: 167-176.
22 Pabst S, Bertram A, Zimmermann T, Schiffer M, de Zwaan M. Physician reported adherence to immunosuppressants in renal transplant patients: Prevalence, agreement, and correlates. J Psychosom Res 2015; 79: 364-371.
23 Pizzo HP, Ettenger RB, Gjertson DW, Reed EF, Zhang J, Gritsch HA, Tsai EW. Sirolimus and tacrolimus coefficient of variation is associated with rejection, donor-specific antibodies, and nonadherence. Pediatr Nephrol 2016; 31: 2345-2352.
24 Rodrigo E, Segundo DS, Fernández-Fresnedo G, López-Hoyos M, Benito A, Ruiz JC, de Cos MA, Arias M. Within-Patient Variability in Tacrolimus Blood Levels Predicts Kidney Graft Loss and Donor-Specific Antibody Development. Transplantation 2016; 100: 2479-2485.
25 Rosenberger EM, Dew MA, Crone C, DiMartini AF. Psychiatric disorders as risk factors for adverse medical outcomes after solid organ transplantation. Curr Opin Organ Transplant 2012; 17: 188-192.
26 Rosenberger EM, DiMartini AF, DeVito AJDabbs, Bermudez CA, Pilewski JM, Toyoda Y, Dew MA. Psychiatric Predictors of Long-term TransplantRelated Outcomes in Lung Transplant Recipients. Transplantation 2016; 100: 239-247.
27 Sellarés J, de Freitas DG, Mengel M, Reeve J, Einecke G, Sis B, Hidalgo LG, Famulski K, Matas A, Halloran PF. Understanding the causes of kidney transplant failure: the dominant role of antibodymediated rejection and nonadherence. Am J Transplant 2012; 12: 388-399.
28 Waiser J, Slowinski T, Brinker-Paschke A, Budde K, Schreiber M, Böhler T, Hauser I, Neumayer HH. Impact of the variability of cyclosporin a trough levels on long-term renal allograft function. Nephrol Dial Transplant 2002; 17: 1310-1317.
29 Ware Jr J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34 (03) 220-233.
30 Whalen HR, Glen JA, Harkins V, Stevens KK, Jardine AG, Geddes CC, Clancy MJ. High intrapatient tacrolimus variability is associated with worse outcomes in renal transplantation using a lowdose tacrolimus immunosuppressive regime. Transplantation 2017; 101: 430-436.
31 Wiebe C, Gibson IW, Blydt-Hansen TD. et al. Evolution and clinical pathologic correlations of de novo donor-specific HLA antibody post kidney transplant. Am J Transplant 2012; 12: 1157-1167.
32 Ziegelmann JP, Griva K, Hankins M, Harrison M, Davenport A, Thompson D, Newman SP. The Transplant Effects Questionnaire (TxEQ): The development of a questionnaire for assessing the multidimensional outcome of organ transplantation – example of end stage renal disease (ESRD). Br J Health Psychol 2002; 07 (Part 4): 393-408.
33 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 1983; 67: 361-370.