From the Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Exp Clin Transplant. 2021 Sep;19(9):948-955. doi: 10.6002/ect.2021.0083. Epub 2021 Aug 9.
In high-income countries, myosteatosis, sarcopenia, and obesity with sarcopenia (sarcopenic obesity) are associated with adverse outcomes after liver transplantation. In South Africa, an upper-middleincome country, we investigated the prevalence and impact of these muscle abnormalities on posttransplant outcomes in adult liver transplant recipients.
We reviewed 106 liver transplant recipients and measured muscle abnormalities on computed tomography using segmentation software. The parameters evaluated were myosteatosis by mean muscle attenuation, sarcopenia by skeletal muscle index at the third lumbar vertebra using validated cutoffs, and sarcopenic obesity as sarcopenia and a body mass index of ≥25 kg/m². The effects of these abnormalities on 1-year patient and graft survival (primary endpoint) and length of hospital and intensive care unit stay, costs, and 90-day and overall postoperative complications (secondary endpoints) were assessed.
Most liver transplant recipients were male (n = 64, 60%). Alcoholic and/or nonalcoholic steatohepatitis were the most frequent indications for transplant (n = 38, 36%). Myosteatosis occurred in 76 patients (72%), 69 patients (65%) had sarcopenia, and 36 patients (34%) had sarcopenic obesity. One year after transplant, myosteatosis was associated with higher mortality (hazard ratio of 3.3; 95% confidence interval, 1.00-11.13; P = .049), greater risk of allograft failure (hazard ratio of 4.1; 95% confidence interval, 1.2-13.5; P = .021), and longer hospital and intensive care unit stays compared with those without myosteatosis. All patients with no body composition abnormalities were alive at 1 year compared with 69% with coexisting myosteatosis and sarcopenia.
In our setting, liver transplant recipients with myosteatosis had a higher risk of death and allograft failure at 1 year compared with patients without body composition abnormalities.
在高收入国家，肌肉减少症、肌少症合并肥胖（肌少性肥胖）与肝移植后不良结局相关。在南非，一个中上收入国家，我们研究了这些肌肉异常在成人肝移植受者中的流行情况及其对移植后结局的影响。
我们回顾了 106 例肝移植受者，并使用分割软件在 CT 上测量肌肉异常。评估的参数包括通过平均肌肉衰减测量的肌减少症、使用验证后的截断值在第三腰椎处测量的骨骼肌指数评估的肌少症、以及肌少症合并肥胖，即肌少症和 BMI≥25kg/m²。评估这些异常对 1 年患者和移植物存活率（主要终点）以及住院和重症监护病房停留时间、费用、90 天和整体术后并发症（次要终点）的影响。
大多数肝移植受者为男性（n=64，60%）。酒精性和/或非酒精性脂肪性肝炎是最常见的移植适应证（n=38，36%）。76 例（72%）患者存在肌减少症，69 例（65%）患者存在肌少症，36 例（34%）患者存在肌少性肥胖。移植后 1 年，肌减少症与更高的死亡率相关（风险比 3.3；95%置信区间，1.00-11.13；P=0.049）、移植物失败风险更高（风险比 4.1；95%置信区间，1.2-13.5；P=0.021），并且与无肌减少症的患者相比，住院和重症监护病房停留时间更长。所有无身体成分异常的患者在 1 年时存活，而同时存在肌减少症和肌少症的患者中，有 69%存活。
在我们的环境中，与无身体成分异常的患者相比，有肌减少症的肝移植受者在 1 年内死亡和移植物失败的风险更高。
