Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Am J Transplant. 2013 Jun;13(6):1549-56. doi: 10.1111/ajt.12221. Epub 2013 Apr 19.
Skeletal muscle depletion, referred to as sarcopenia, predicts morbidity and mortality in patients undergoing digestive surgery. However, the impact on liver transplantation is unclear. The present study investigated the impact of sarcopenia on patients undergoing living donor liver transplantation (LDLT). Sarcopenia was assessed by a body composition analyzer in 124 adult patients undergoing LDLT between February 2008 and April 2012. The correlation of sarcopenia with other patient factors and the impact of sarcopenia on survival after LDLT were analyzed. The median ratio of preoperative skeletal muscle mass was 92% (range, 67-130%) of the standard mass. Preoperative skeletal muscle mass was significantly correlated with the branched-chain amino acids to tyrosine ratio (r = -0.254, p = 0.005) and body cell mass (r = 0.636, p < 0.001). The overall survival rate in patients with low skeletal muscle mass was significantly lower than in patients with normal/high skeletal muscle mass (p < 0.001). Perioperative nutritional therapy significantly increased overall survival in patients with low skeletal muscle mass (p = 0.009). Multivariate analysis showed that low skeletal muscle mass was an independent risk factor for death after transplantation. In conclusion, sarcopenia was closely involved with posttransplant mortality in patients undergoing LDLT. Perioperative nutritional therapy significantly improved overall survival in patients with sarcopenia.
骨骼肌减少，称为肌肉减少症，可预测接受消化系统手术的患者的发病率和死亡率。然而，其对肝移植的影响尚不清楚。本研究探讨了肌肉减少症对接受活体供肝移植（LDLT）的患者的影响。在 2008 年 2 月至 2012 年 4 月期间，通过身体成分分析仪对 124 名接受 LDLT 的成年患者进行了肌肉减少症评估。分析了肌肉减少症与其他患者因素的相关性，以及肌肉减少症对 LDLT 后生存的影响。术前骨骼肌质量比的中位数为 92%（范围，67-130%）标准质量。术前骨骼肌质量与支链氨基酸与酪氨酸比（r = -0.254，p = 0.005）和体细胞质量（r = 0.636，p < 0.001）呈显著相关。骨骼肌质量低的患者总生存率明显低于骨骼肌质量正常/高的患者（p < 0.001）。围手术期营养治疗可显著提高骨骼肌质量低的患者的总生存率（p = 0.009）。多因素分析显示，骨骼肌质量低是移植后死亡的独立危险因素。总之，肌肉减少症与 LDLT 后患者的移植后死亡率密切相关。围手术期营养治疗可显著提高肌肉减少症患者的总生存率。
