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?

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

› Author Affiliations

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

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