Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany.
Department of Hepatology and Gastroenterology, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.
J Cachexia Sarcopenia Muscle. 2021 Apr;12(2):358-367. doi: 10.1002/jcsm.12669. Epub 2021 Feb 1.
Myosteatosis is associated with perioperative outcomes in orthotopic liver transplantation (OLT). Here, we investigated the effects of body composition and myosteatosis on long-term graft and patient survival following OLT.
Clinical data from 225 consecutive OLT recipients from a prospective database were retrospectively analysed (May 2010 to December 2017). Computed tomography-based lumbar skeletal muscle index (SMI) (muscle mass) and mean skeletal muscle radiation attenuation (SM-RA) (myosteatosis) were calculated using a segmentation tool (3D Slicer). Patients with low skeletal muscle mass (low SMI) and myosteatosis (low SM-RA) were identified using predefined and validated cut-off values.
The mean donor and recipient age was 55 ± 16 and 54 ± 12 years, respectively. Some 67% of the recipients were male. The probability of graft and patient survival was significantly lower in patients with myosteatosis compared with patients with higher SM-RA values (P = 0.011 and P = 0.001, respectively). Low skeletal muscle mass alone was not associated with graft and patient survival (P = 0.273 and P = 0.278, respectively). Dividing the cohort into quartiles, based on the values of SMI and SM-RA, resulted in significant differences in patient but not in graft survival (P = 0.011). Even though multivariable analysis identified low SM-RA as an important prognostic marker (hazard ratio: 2.260, 95% confidence interval: 1.177-4.340, P = 0.014), myosteatosis lost its significance when early mortality (90 days) was excluded from the final multivariable model. Patients with myosteatosis showed significantly higher all-cause mortality and in particular higher rates of deaths due to respiratory and septic complication (P = 0.002, P = 0.022, and P = 0.049, respectively).
Preoperative myosteatosis may be an important prognostic marker in patients undergoing deceased donor liver transplantation. The prognostic value of myosteatosis seems to be particularly important in the early post-operative phase. Validation in prospective clinical trials is warranted.
肌肉减少症与原位肝移植（OLT）的围手术期结局相关。在这里，我们研究了体成分和肌肉减少症对 OLT 后长期移植物和患者存活率的影响。
回顾性分析了来自前瞻性数据库的 225 例连续 OLT 受者的临床数据（2010 年 5 月至 2017 年 12 月）。使用分割工具（3D Slicer）计算基于 CT 的腰椎骨骼肌指数（SMI）（肌肉质量）和平均骨骼肌辐射衰减（SM-RA）（肌肉减少症）。使用预定义和验证的截止值确定骨骼肌质量低（低 SMI）和肌肉减少症（低 SM-RA）的患者。
平均供体和受者年龄分别为 55±16 岁和 54±12 岁。受者中 67%为男性。与 SM-RA 值较高的患者相比，患有肌肉减少症的患者移植物和患者存活率显著降低（P=0.011 和 P=0.001）。单独的骨骼肌质量低与移植物和患者存活率无关（P=0.273 和 P=0.278）。根据 SMI 和 SM-RA 的值将队列分为四分位数，患者的生存率存在显著差异，但移植物的生存率没有差异（P=0.011）。尽管多变量分析确定低 SM-RA 是一个重要的预后标志物（危险比：2.260，95%置信区间：1.177-4.340，P=0.014），但当将 90 天内的早期死亡率排除在最终多变量模型之外时，肌肉减少症失去了其意义。患有肌肉减少症的患者全因死亡率明显更高，特别是因呼吸和脓毒症并发症导致的死亡率更高（P=0.002，P=0.022，P=0.049）。
术前肌肉减少症可能是接受已故供体肝移植患者的一个重要预后标志物。肌肉减少症的预后价值在术后早期阶段似乎尤为重要。需要在前瞻性临床试验中进行验证。
