Division of Gastroenterology, University of Alberta Hospital, Edmonton, Canada; Liver Unit, University of Alberta Hospital, Edmonton, Canada.
Liver Transpl. 2014 Jun;20(6):640-8. doi: 10.1002/lt.23863. Epub 2014 Mar 26.
Muscle depletion or sarcopenia is associated with increased mortality in patients with cirrhosis; how it affects mortality after liver transplantation requires further study. In this study, we aimed to establish whether sarcopenia predicts increased morbidity or mortality after liver transplantation. We analyzed 248 patients with cirrhosis who had a computed tomography (CT) scan including the third lumbar vertebra before liver transplantation. Data were recovered from medical charts, the skeletal muscle cross-sectional area was measured with CT, and sarcopenia was defined with previously published sex- and body mass index-specific cutoffs. One hundred sixty-nine patients (68%) were male, and the mean age at transplantation was 55 ± 1 years. The etiologies of cirrhosis were hepatitis C virus (51%), alcohol (19%), autoimmune liver diseases (15%), hepatitis B virus (8%), and other etiologies (7%). Sarcopenia was present in 112 patients (45%), and it was more frequent in males (P = 0.002), patients with ascites (P = 0.02), and patients with higher bilirubin levels (P = 0.05), creatinine levels (P = 0.02), international normalized ratios (P = 0.04), Child-Pugh scores (P = 0.002), and Model for End-Stage Liver Disease scores (P = 0.002). The median survival period after liver transplantation was 117 ± 17 months for sarcopenic patients and 146 ± 20 months for nonsarcopenic patients (P = 0.4). Sarcopenic patients had longer hospital stays (40 ± 4 versus 25 ± 3 days; P = 0.005) and a higher frequency of bacterial infections within the first 90 days after liver transplantation (26% versus 15%, P = 0.04) in comparison with nonsarcopenic patients. In conclusion, sarcopenia is one of the most common complications in patients with cirrhosis and is predictive of longer hospital stays and a higher risk of perioperative bacterial infections after liver transplantation, but it is not associated with increased mortality.
肌肉减少症或肌少症与肝硬化患者的死亡率增加有关；它如何影响肝移植后的死亡率需要进一步研究。在这项研究中，我们旨在确定肌少症是否预测肝移植后发病率或死亡率增加。我们分析了 248 例肝硬化患者的计算机断层扫描（CT）扫描，包括肝移植前的第三腰椎。数据从病历中恢复，用 CT 测量骨骼肌横截面积，用以前发表的性别和体重指数特异性截止值定义肌少症。169 例（68%）为男性，移植时的平均年龄为 55±1 岁。肝硬化的病因是丙型肝炎病毒（51%）、酒精（19%）、自身免疫性肝病（15%）、乙型肝炎病毒（8%）和其他病因（7%）。112 例（45%）患者存在肌少症，男性更为常见（P=0.002）、有腹水的患者（P=0.02）和胆红素水平较高的患者（P=0.05）、肌酐水平（P=0.02）、国际标准化比值（P=0.04）、Child-Pugh 评分（P=0.002）和终末期肝病模型评分（P=0.002）。肝移植后肌少症患者的中位生存时间为 117±17 个月，非肌少症患者为 146±20 个月（P=0.4）。与非肌少症患者相比，肌少症患者的住院时间更长（40±4 与 25±3 天；P=0.005），肝移植后 90 天内细菌感染的发生率更高（26%与 15%，P=0.04）。总之，肌少症是肝硬化患者最常见的并发症之一，与肝移植后住院时间延长和围手术期细菌感染风险增加相关，但与死亡率增加无关。
