Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
Liver Transpl. 2013 Dec;19(12):1396-402. doi: 10.1002/lt.23752. Epub 2013 Oct 21.
Although sarcopenia (muscle loss) is associated with increased mortality after liver transplantation, its influence on other complications is less well understood. We examined the association between sarcopenia and the risk of severe posttransplant infections among adult liver transplant recipients. By calculating the total psoas area (TPA) on preoperative computed tomography scans, we assessed sarcopenia among 207 liver transplant recipients. The presence or absence of a severe posttransplant infection was determined by a review of the medical chart. The influence of posttransplant infections on overall survival was also assessed. We identified 196 episodes of severe infections among 111 patients. Fifty-six patients had more than 1 infection. The median time to the development of an infection was 27 days (interquartile range = 13-62 days). When the patients were grouped by TPA tertiles, patients in the lowest tertile had a greater than 4-fold higher chance of developing a severe infection in comparison with patients in the highest tertile (odds ratio = 4.6, 95% confidence interval = 2.25-9.53). In a multivariate analysis, recipient age (hazard ratio = 1.04, P = 0.02), pretransplant TPA (hazard ratio = 0.38, P < 0.01), and pretransplant total bilirubin level (hazard ratio = 1.05, P = 0.02) were independently associated with the risk of developing severe infections. Patients with severe posttransplant infections had worse 1-year survival than patients without infections (76% versus 92%, P = 0.003). In conclusion, among patients undergoing liver transplantation, a lower TPA was associated with a heightened risk for posttransplant infectious complications and mortality. Future efforts should focus on approaches for assessing and mitigating vulnerability in patients undergoing transplantation.
虽然肌肉减少症（肌肉损失）与肝移植后死亡率增加有关，但它对其他并发症的影响知之甚少。我们研究了肌肉减少症与成人肝移植受者发生严重移植后感染风险之间的关系。通过计算术前 CT 扫描的总竖脊肌面积（TPA），我们评估了 207 例肝移植受者的肌肉减少症情况。通过查阅病历确定是否发生严重的移植后感染。还评估了移植后感染对总生存率的影响。我们在 111 名患者中发现了 196 例严重感染。56 名患者感染超过 1 次。感染的中位时间为 27 天（四分位距= 13-62 天）。当根据 TPA 三分位分组时，与最高三分位的患者相比，最低三分位的患者发生严重感染的几率增加了 4 倍以上（比值比= 4.6，95%置信区间= 2.25-9.53）。在多变量分析中，受者年龄（风险比= 1.04，P= 0.02）、移植前 TPA（风险比= 0.38，P<0.01）和移植前总胆红素水平（风险比= 1.05，P= 0.02）与发生严重感染的风险独立相关。发生严重移植后感染的患者 1 年生存率低于未发生感染的患者（76%对 92%，P= 0.003）。总之，在接受肝移植的患者中，较低的 TPA 与移植后感染性并发症和死亡率增加相关。未来的研究应重点关注评估和减轻移植患者脆弱性的方法。
