Yadav Anitha, Chang Yu-Hui, Carpenter Sarah, Silva Alvin C, Rakela Jorge, Aqel Bashar A, Byrne Thomas J, Douglas David D, Vargas Hugo E, Carey Elizabeth J
Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA.
Clin Transplant. 2015 Feb;29(2):134-41. doi: 10.1111/ctr.12493. Epub 2015 Jan 9.
Sarcopenia, or loss of skeletal muscle mass, is associated with increased mortality and morbidity in liver transplant (LT) candidates. Six-minute walk distance (6MWD) and health-related quality of life (HRQOL) as assessed by short form 36 scores (SF-36) also impact clinical outcomes in these patients. This study explored the relationship between the sarcopenia, 6MWD, and HRQOL in LT candidates. Sarcopenia was evaluated based on skeletal muscle mass index (SMI) quantified from abdominal computed tomography. Patients were followed until death, removal from the wait list or the end of the study period. Two hundred and thirteen patients listed for LT were included. The mean SMI, 6MWD and mean gait speed were 54.3 ± 9.7, 370.5 m and 1 m/s, respectively. Sarcopenia was noted in 22.2% of LT candidates. There was no correlation between sarcopenia, 6MWD, and SF-36 scores. The 6MWD, but not sarcopenia, was an independent predictor of mortality (hazard ratio = 2.1 [0.9-4.7]). In summary, sarcopenia did not emerge as a significant predictor of waitlist mortality and also failed to correlate with either functional capacity or HRQOL in LT candidates. In patients with ESLD awaiting LT, 6MWD appears to be a more useful prognostic indicator than the presence of sarcopenia.
肌肉减少症，即骨骼肌质量的丧失，与肝移植（LT）候选者的死亡率和发病率增加有关。通过简短健康调查问卷36项评分（SF-36）评估的6分钟步行距离（6MWD）和健康相关生活质量（HRQOL）也会影响这些患者的临床结局。本研究探讨了LT候选者中肌肉减少症、6MWD和HRQOL之间的关系。根据腹部计算机断层扫描定量的骨骼肌质量指数（SMI）评估肌肉减少症。对患者进行随访直至死亡、从等待名单中移除或研究期结束。纳入了213名等待LT的患者。平均SMI、6MWD和平均步速分别为54.3±9.7、370.5米和1米/秒。22.2%的LT候选者存在肌肉减少症。肌肉减少症、6MWD和SF-36评分之间无相关性。6MWD而非肌肉减少症是死亡率的独立预测因素（风险比=2.1[0.9-4.7]）。总之，肌肉减少症并非等待名单死亡率的显著预测因素，在LT候选者中也与功能能力或HRQOL无关。在等待LT的终末期肝病患者中，6MWD似乎是比肌肉减少症更有用的预后指标。
