Dhaliwal Amaninder, Larson Diana, Hiat Molly, Muinov Lyudmila M, Harrison William L, Sayles Harlan, Sempokuya Tomoki, Olivera Marco A, Rochling Fedja A, McCashland Timothy M
Department of Gastroenterology and Hepatology, University of South Florida and Moffitt Cancer Center, Tampa, FL 33612, United States.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States.
World J Hepatol. 2020 Oct 27;12(10):807-815. doi: 10.4254/wjh.v12.i10.807.
Sarcopenia, which is a loss of skeletal muscle mass, has been reported to increase post-transplant mortality and morbidity in patients undergoing the first liver transplant. Cross-sectional imaging modalities typically determine sarcopenia in patients with cirrhosis by measuring core abdominal musculatures. However, there is limited evidence for sarcopenia related outcomes in patients undergoing liver re-transplantation (re-OLT).
To evaluate the risk of mortality in patients with pre-existing sarcopenia following liver re-OLT.
This is a retrospective study of all adult patients who had undergone a liver re-OLT at the University of Nebraska Medical Center from January 1, 2007 to January 1, 2017. We divided patients into sarcopenia and no sarcopenia groups. "TeraRecon AquariusNet 4.4.12.194" software was used to evaluate computed tomography or magnetic resonance imaging of the patients done within one year prior to their re-OLT, to calculate the Psoas muscle area at L3-L4 intervertebral disc. We defined cutoffs for sarcopenia as < 1561 mm for males and < 1464 mm for females. The primary outcome was to compare 90 d, one, and 5-year survival rates. We also compared complications after re-OLT, length of stay, and re-admission within 30 d. Survival analysis was performed with Kaplan-Meier survival analysis. Continuous variables were evaluated with Wilcoxon rank-sum tests. Categorical variables were evaluated with Fisher's exact tests.
Fifty-seven patients were included, 32 males: 25 females, median age 50 years. Two patients were excluded due to incomplete information. Overall, 47% (26) of patients who underwent re-OLT had sarcopenia. Females were found to have significantly more sarcopenia than males (73% 17%, < 0.001). Median model for end stage liver disease at re-OLT was 28 in both sarcopenia and no sarcopenia groups. Patients in the no sarcopenia group had a trend of longer median time between the first and second transplant (36.5 mo 16.7 mo). Biological markers, outcome parameters, and survival at 90 d, 1 and 5 years, were similar between the two groups. Sarcopenia in re-OLT at our center was noted to be twice as common (47%) as historically reported in patients undergoing primary liver transplantation.
Overall survival and outcome parameters were no different in those with and without the evidence of sarcopenia after re-OLT.
肌肉减少症是指骨骼肌质量的丧失，据报道，在接受首次肝移植的患者中，肌肉减少症会增加移植后的死亡率和发病率。横断面成像方式通常通过测量腹部核心肌肉组织来确定肝硬化患者是否存在肌肉减少症。然而，关于再次肝移植（re-OLT）患者肌肉减少症相关结局的证据有限。
评估再次肝移植前已存在肌肉减少症的患者的死亡风险。
这是一项对2007年1月1日至2017年1月1日在内布拉斯加大学医学中心接受再次肝移植的所有成年患者的回顾性研究。我们将患者分为肌肉减少症组和非肌肉减少症组。使用“TeraRecon AquariusNet 4.4.12.194”软件评估患者在再次肝移植前一年内进行的计算机断层扫描或磁共振成像，以计算L3-L4椎间盘水平的腰大肌面积。我们将男性肌肉减少症的临界值定义为<1561平方毫米，女性为<1464平方毫米。主要结局是比较90天、1年和5年生存率。我们还比较了再次肝移植后的并发症、住院时间和30天内的再次入院情况。采用Kaplan-Meier生存分析进行生存分析。连续变量采用Wilcoxon秩和检验进行评估。分类变量采用Fisher精确检验进行评估。
纳入57例患者，男性32例，女性25例，中位年龄50岁。2例患者因信息不完整被排除。总体而言，接受再次肝移植的患者中有47%（26例）存在肌肉减少症。发现女性的肌肉减少症明显多于男性（73%对17%，P<0.001）。再次肝移植时终末期肝病模型评分中位数在肌肉减少症组和非肌肉减少症组均为28。非肌肉减少症组患者首次和第二次移植之间的中位时间有延长趋势（36.5个月对16.7个月）。两组在90天、1年和5年时的生物学标志物、结局参数和生存率相似。我们中心再次肝移植患者的肌肉减少症发生率（47%）是既往报道的初次肝移植患者的两倍。
再次肝移植后有或无肌肉减少症证据的患者的总体生存率和结局参数无差异。
