Hammad Ahmed, Kaido Toshimi, Hamaguchi Yuhei, Okumura Shinya, Kobayashi Atsushi, Shirai Hisaya, Kamo Naoko, Yagi Shintaro, Uemoto Shinji
Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Surgery, Mansoura University, Mansoura, Egypt.
Hepatobiliary Surg Nutr. 2017 Dec;6(6):367-378. doi: 10.21037/hbsn.2017.02.02.
The effect of body composition disturbances has been recently in focus. Sarcopenic obesity, a co-occurrence of low muscle mass and high body fat was reportedly predictive of high mortality in patients with cirrhosis. However, the impact of the interacting sarcopenia and overweight on the outcomes after liver transplantation is still unclear.
We evaluated 200 patients undergoing adult-to-adult living donor liver transplantation at our institution between January 2008 and November 2013 classified according to BMI and psoas muscle index (PMI) on admission to transplant into 4 subgroups; sarcopenic overweight (SO), sarcopenic non-overweight (SN), non-sarcopenic overweight and non-sarcopenic non-overweight (NN). Short-term outcomes and overall post-transplant survival were compared among the four subgroups.
Sarcopenic patients with preoperative low PMI had higher incidence of postoperative bacteremia and major postoperative complications, and poorer overall post-transplant survival than non-sarcopenic patients with normal/high PMI (P<0.001, respectively). Overweight recipients had a significantly higher overall survival (OS) rate than non-overweight patients (P=0.021). SO subgroup (low PMI and BMI ≥25) had statistically indifferent incidence of postoperative bacteremia, major postoperative complications or overall post-transplant survival than other recipients. In contrast, SN subgroup (low PMI and BMI <25) had higher incidence of postoperative bacteremia (P<0.001), major postoperative complications (P<0.001) than the SO subgroup and possessed the poorest OS among the four recipient subgroups (P=0.001).
In living donor liver transplantation, preoperative SO did not confer added significant morbidity or mortality risks than the stand-alone sarcopenia.
身体成分紊乱的影响近来备受关注。据报道，肌肉减少性肥胖，即低肌肉量与高体脂并存，是肝硬化患者高死亡率的预测因素。然而，肌肉减少症与超重的相互作用对肝移植术后结局的影响仍不明确。
我们评估了200例在2008年1月至2013年11月期间在我院接受成人对成人活体肝移植的患者，根据移植入院时的体重指数（BMI）和腰大肌指数（PMI）将其分为4个亚组；肌肉减少性超重（SO）、肌肉减少性非超重（SN）、非肌肉减少性超重和非肌肉减少性非超重（NN）。比较了四个亚组的短期结局和移植后总体生存率。
术前PMI低的肌肉减少症患者术后菌血症和主要术后并发症的发生率高于PMI正常/高的非肌肉减少症患者，移植后总体生存率也较差（分别为P<0.001）。超重受者的总生存率（OS）显著高于非超重患者（P=0.021）。SO亚组（PMI低且BMI≥25）术后菌血症、主要术后并发症或移植后总体生存率的发生率与其他受者相比无统计学差异。相比之下，SN亚组（PMI低且BMI<25）术后菌血症的发生率（P<0.001）、主要术后并发症的发生率（P<0.001）高于SO亚组，且在四个受者亚组中OS最差（P=0.001）。
在活体肝移植中，术前SO与单纯肌肉减少症相比，并未增加显著的发病或死亡风险。
