Meier Raphael P H, Noguchi Hiroshi, Kelly Yvonne M, Sarwal Minnie, Conti Giulia, Ward Casey, Halleluyan Ran, Tavakol Mehdi, Stock Peter G, Freise Chris E
Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA.
Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Transplant Direct. 2020 Sep 25;6(10):e610. doi: 10.1097/TXD.0000000000001053. eCollection 2020 Oct.
Sarcopenia has been identified as a predictive variable for surgical outcomes. We hypothesized that sarcopenia could be a key measure to identify frail patients and potentially predict poorer outcomes among recipients of simultaneous pancreas and kidney (SPK) transplants.
We estimated sarcopenia by measuring psoas muscle mass index (PMI). PMI was assessed on perioperative computed tomography (CT) scans of SPK recipients.
Of the 141 patients identified between 2010 and 2018, 107 had a CT scan available and were included in the study. The median follow-up was 4 years (range, 0.5-9.1 y). Twenty-three patients had a low PMI, and 84 patients had a normal PMI. Patient characteristics were similar between the 2 groups except for body mass index, which was significantly lower in low PMI group ( < 0.001). Patient and kidney graft survival were not statistically different between groups ( = 0.851 and = 0.357, respectively). A multivariate Cox regression analysis showed that patients with a low PMI were 6 times more likely to lose their pancreas allograft (hazard ratios, 5.4; 95% confidence intervals, 1.4-20.8; = 0.015). Three out of 6 patients lost their pancreas graft due to rejection in the low PMI group, compared with 1 out of 9 patients in the normal PMI group. Among low PMI patients who had a follow-up CT scan, 62.5% (5/8) of those with a functional pancreas graft either improved or resolved sarcopenia, whereas 75.0% (3/4) of those who lost their pancreas graft continued to lose muscle mass.
Sarcopenia could represent one of the predictors of pancreas graft failure and should be evaluated and potentially optimized in SPK recipients.
肌肉减少症已被确定为手术结果的预测变量。我们假设，肌肉减少症可能是识别虚弱患者的关键指标，并有可能预测同期胰肾联合移植（SPK）受者的不良预后。
我们通过测量腰大肌质量指数（PMI）来评估肌肉减少症。在SPK受者的围手术期计算机断层扫描（CT）上评估PMI。
在2010年至2018年间确定的141例患者中，107例有可用的CT扫描并纳入研究。中位随访时间为4年（范围0.5 - 9.1年）。23例患者PMI较低，84例患者PMI正常。两组患者的特征相似，但体重指数除外，低PMI组的体重指数显著更低（<0.001）。两组间患者和肾移植存活率无统计学差异（分别为 = 0.851和 = 0.357）。多因素Cox回归分析显示，PMI较低的患者失去胰腺移植物的可能性高6倍（风险比，5.4；95%置信区间，1.4 - 20.8； = 0.015）。低PMI组6例患者中有3例因排斥反应失去胰腺移植物，而正常PMI组9例患者中有1例。在进行了随访CT扫描的低PMI患者中，有功能胰腺移植物的患者中有62.5%（5/8）的肌肉减少症得到改善或缓解，而失去胰腺移植物的患者中有75.0%（3/4）继续出现肌肉量减少。
肌肉减少症可能是胰腺移植物失败的预测因素之一，在SPK受者中应进行评估并可能加以优化。
