>From the Department of Transplant Nephrology and Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
Exp Clin Transplant. 2020 Nov;18(6):682-688. doi: 10.6002/ect.2020.0027. Epub 2020 Aug 14.
Our aim was to investigate effects of surgery on living donors' body composition and clarify factors related to it.
We evaluated preoperative computed tomography images of 335 living kidney donors (127 men, 209 women) to calculate 3 body composition parameters and changes with aging by sex: (1) skeletal muscle mass, quantified by skeletal muscle index; (2) fat distribution, calculated by visceral adipose tissue/subcutaneous adipose tissue ratio; and (3) muscle quality, quantified by intramuscular adipose tissue content. Thereafter, with pre- and postoperative computed tomography images from 75 living kidney donors (25 men, 50 women) after hand-assisted laparoscopic donor nephrectomy, we compared pre- and postoperative body composition changes.
Annual change in intramuscular adipose tissue content with age was 0.0049 in men and 0.0091 in women. Of 75 patients, 49 had lower quality of muscle, intramuscular adipose tissue content was significantly higher after nephrectomy (P < .001), and median change in intramuscular adipose tissue content was 0.061 (range, 0.018-0.11) in men and 0.052 (range, 0.017-0.18) in women. Univariate analysis revealed that skeletal mass index and visceral adipose tissue/subcutaneous adipose tissue ratio changes were significantly different between the intramuscular adipose tissue content improvement and deterioration groups. Multivariate analysis revealed skeletal mass index change was an independent factor for intramuscular adipose tissue content change (P = .0019). Intramuscular adipose tissue content change was negatively correlated with skeletal mass index change (r = -0.40).
Although muscle quality deteriorates after nephrectomy, maintaining muscle mass is important to retaining muscle quality.
本研究旨在探讨手术对活体供者身体成分的影响，并明确相关影响因素。
我们评估了 335 名活体肾供者（男 127 例，女 209 例）的术前 CT 图像，以计算 3 项身体成分参数，并按性别分析随年龄的变化：（1）骨骼肌质量，用骨骼肌指数表示；（2）脂肪分布，通过内脏脂肪组织/皮下脂肪组织比计算；（3）肌肉质量，用肌内脂肪含量表示。随后，我们比较了 75 例行手助腹腔镜供肾切除术的活体供者（男 25 例，女 50 例）术前和术后 CT 图像，评估其术后身体成分的变化。
男性和女性的肌内脂肪含量随年龄的年变化率分别为 0.0049 和 0.0091。在 75 例患者中，49 例肌肉质量下降，术后肌内脂肪含量明显升高（P＜0.001），男性和女性的肌内脂肪含量中位数分别增加 0.061（范围：0.018-0.11）和 0.052（范围：0.017-0.18）。单因素分析显示，肌内脂肪含量改善和恶化组的骨骼肌指数和内脏脂肪组织/皮下脂肪组织比变化有显著差异。多因素分析显示，骨骼肌指数变化是肌内脂肪含量变化的独立因素（P=0.0019）。肌内脂肪含量变化与骨骼肌指数变化呈负相关（r=-0.40）。
尽管肾切除术后肌肉质量下降，但保持肌肉量对于维持肌肉质量很重要。
