Masuda Toshiro, Shirabe Ken, Ikegami Toru, Harimoto Norifumi, Yoshizumi Tomoharu, Soejima Yuji, Uchiyama Hideaki, Ikeda Tetsuo, Baba Hideo, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Liver Transpl. 2014 Apr;20(4):401-7. doi: 10.1002/lt.23811. Epub 2014 Jan 27.
The aims of this study were to investigate sarcopenia as a novel predictor of mortality and sepsis after living donor liver transplantation (LDLT) and to evaluate the effects of early enteral nutrition on patients with sarcopenia. Two hundred four patients undergoing preoperative computed tomography within the month before LDLT were retrospectively evaluated. The lengths of the major and minor axes of the psoas muscle were simply measured at the caudal end of the third lumbar vertebra, and the area of the psoas muscle was calculated. A psoas muscle area lower than the 5th percentile for healthy donors of each sex was defined as sarcopenia. Ninety-six of the 204 patients (47.1%), including 58.3% (60/103) of the male patients and 35.6% (36/101) of the female patients, were diagnosed with sarcopenia. Sarcopenia was independently and significantly associated with overall survival: there was an approximately 2-fold higher risk of death for patients with sarcopenia versus patients without sarcopenia (hazard ratio = 2.06, P = 0.047). Sarcopenia was an independent predictor of postoperative sepsis (hazard ratio = 5.31, P = 0.009). Other independent predictors were a younger recipient age (P < 0.001) and a higher body mass index (P = 0.02). Early enteral nutrition within the first 48 hours after LDLT was performed for 24.2% in 2003-2007 and for 100% in 2008-2011, and the incidence of postoperative sepsis for patients with sarcopenia (n = 96) was 28.2% (11/39) in 2003-2007 and 10.5% (6/57) in 2008-2011 (P = 0.03). In conclusion, sarcopenia is an independent predictor of mortality and sepsis after LDLT. The incidence of postoperative sepsis was reduced even in patients with sarcopenia after the routine application of early enteral nutrition.
本研究的目的是调查肌肉减少症作为活体肝移植（LDLT）后死亡率和脓毒症的一种新的预测指标，并评估早期肠内营养对肌肉减少症患者的影响。对204例在LDLT前一个月内接受术前计算机断层扫描的患者进行回顾性评估。在第三腰椎尾端简单测量腰大肌的长轴和短轴长度，并计算腰大肌面积。将低于各性别健康供体第5百分位数的腰大肌面积定义为肌肉减少症。204例患者中有96例（47.1%）被诊断为肌肉减少症，其中男性患者占58.3%（60/103），女性患者占35.6%（36/101）。肌肉减少症与总体生存率独立且显著相关：与无肌肉减少症的患者相比，有肌肉减少症的患者死亡风险高出约2倍（风险比=2.06，P=0.047）。肌肉减少症是术后脓毒症的独立预测指标（风险比=5.31，P=0.009）。其他独立预测指标为受者年龄较小（P<0.001）和体重指数较高（P=0.02）。2003 - 2007年，LDLT后48小时内进行早期肠内营养的比例为24.2%，2008 - 2011年为100%，2003 - 2007年肌肉减少症患者（n = 96）术后脓毒症的发生率为28.2%（11/39），2008 - 2011年为10.5%（6/57）（P = 0.03）。总之，肌肉减少症是LDLT后死亡率和脓毒症的独立预测指标。常规应用早期肠内营养后，即使是肌肉减少症患者，术后脓毒症的发生率也有所降低。
