Department of Rehabilitation, Tohoku University Hospital, Sendai, Miyagi, Japan.
Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan.
BMC Pulm Med. 2021 Apr 16;21(1):124. doi: 10.1186/s12890-021-01442-5.
Lung transplant (LTX) can provide a survival benefit and improve physical function for selected patients with advanced pulmonary disease. Sarcopenia is a systemic muscle-failure that can be found in a variety of life stages and disabilities. In this study, we follow the evolution of each variable defined in sarcopenia and the outcomes in LTX recipients with post-transplant sarcopenia.
Patients who underwent LTX at Tohoku University Hospital between 2013 and 2018 were consecutively included in the retrospective cohort study, with follow-up to 2019. Sarcopenia was defined by low muscle mass (the cross-sectional area (CSA) of erector spinae muscle (ESM) in thoracic CT with a threshold < 17.24 cm/m) and either low muscle strength (hand-grip with a threshold of < 26 kg in males and of < 18 kg in females) or physical performance (6-min walk distance with a threshold < 46.5% of predicted distance).
Fifty-five recipients were included into the study, of whom 19 patients were defined as sarcopenic and 36 as non-sarcopenic. The muscle mass improved after transplant in both sarcopenic and non-sarcopenic individuals: the median ESM-CSA enlarged from 17.25 cm/m in 2 months post-LTX to 18.55 cm/m in 12 months (p < 0.001) and 17.63 cm/m in 36 months (p < 0.001) in non-sarcopenic individuals, while in sarcopenic patients it improved from 13.36 cm/m in 2 months to 16.31 cm/m in 12 months (p < 0.005) and 18.01 cm/m in 36 months (p < 0.001). The muscle mass in sarcopenia substantially recovered to close to non-sarcopenic conditions within 36-months (p < 0.001 in 2 months and p = 0.951 in 36 months). Accordingly, muscle strength and physical performance in both groups improved over time. No difference in survival was seen in both groups (Log-rank p = 0.096), and sarcopenia was not associated with an overall hazard of death (p = 0.147). There was no difference in the cumulative incidence of chronic lung allograft dysfunction between patients with or without sarcopenia (Log-rank p = 0.529).
Even patients with post-transplant sarcopenia have a chance to recover physical function to levels close to those without sarcopenia several years post LTX.
肺移植（LTX）可以为选定的晚期肺部疾病患者提供生存获益和改善身体机能。肌肉减少症是一种全身性肌肉衰竭，可发生在各种生命阶段和残疾中。在这项研究中，我们观察了移植后肌肉减少症（post-transplant sarcopenia）患者的每一个定义变量的演变，以及这些患者的结局。
2013 年至 2018 年在东北大学医院接受 LTX 的患者连续纳入回顾性队列研究，随访至 2019 年。肌肉减少症的定义为肌肉量低（CT 横断面上的竖脊肌截面积（CSA）低于 17.24 cm/m）和/或肌肉力量低（男性握力低于 26 公斤，女性握力低于 18 公斤）或身体机能差（6 分钟步行距离低于预测距离的 46.5%）。
共有 55 名患者纳入研究，其中 19 名患者被定义为肌肉减少症患者，36 名患者为非肌肉减少症患者。肌肉质量在移植后都有所改善：非肌肉减少症患者的竖脊肌 CSA 中位数从 LTX 后 2 个月的 17.25 cm/m 增加到 12 个月的 18.55 cm/m（p<0.001）和 36 个月的 17.63 cm/m（p<0.001）；而肌肉减少症患者则从 LTX 后 2 个月的 13.36 cm/m 增加到 12 个月的 16.31 cm/m（p<0.005）和 36 个月的 18.01 cm/m（p<0.001）。肌肉减少症患者的肌肉质量在 36 个月内基本恢复到非肌肉减少症状态（2 个月时 p<0.001，36 个月时 p=0.951）。因此，两组患者的肌肉力量和身体机能随时间推移而改善。两组患者的生存率无差异（对数秩检验 p=0.096），肌肉减少症与全因死亡的总体风险无关（p=0.147）。有或没有肌肉减少症的患者慢性肺移植物功能障碍的累积发生率无差异（对数秩检验 p=0.529）。
即使是移植后出现肌肉减少症的患者，也有机会在 LTX 后数年恢复到接近无肌肉减少症的身体机能水平。
