College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Sci Rep. 2021 Sep 28;11(1):19247. doi: 10.1038/s41598-021-98399-6.
Despite technological and immunological innovations, living-donor liver transplant (LDLT) recipients still face substantial risk of postoperative complications. Sarcopenia is being recognized more and more as a biomarker that correlates with poor outcomes in surgical patients. The purpose of this study was to evaluate the relationship between sarcopenia and significant surgical complications in LDLT recipients. This retrospective review included patients who had received LDLT at our institute from 2005 to 2017. Sarcopenia was assessed using the psoas muscle index (PMI) in cross-sectional images. ROC curve analysis was used to determine the ability of PMI to predict postoperative complications. Correlations between major postoperative complications and sarcopenia were evaluated using regression analysis. A total of 271 LDLT recipients were included. No significant differences were found between PMI and major postoperative complications in male patients. Female recipients with major postoperative complications had significantly lower mean PMI values (P = 0.028), and the PMI cut-off value was 2.63 cm/m. Postoperative massive pleural effusion requiring pigtail drainage occurred more frequently in the sarcopenia group than in the non-sarcopenia group (P = 0.003). 1-, 3-, 5- and 10-year overall survival rates in female were significantly poorer in the sarcopenia group (n = 14) compared with the non-sarcopenia group (n = 108), at 92.9% versus 97.2%, 85.7% versus 95.4%, 85.7% versus 92.5% and 70.1 versus 82.0%, respectively (P = 0.041) and 94.6%, 89.9%, 85.9% and 78.5% in male patients. Sarcopenia is associated with a significantly higher risk of major postoperative complications in females. PMI and sarcopenia together are predictive of major postoperative complications and survival rates in female LDLT recipients.
尽管在技术和免疫方面有所创新，活体肝移植（LDLT）受者术后仍面临大量并发症的风险。肌肉减少症越来越被认为是与手术患者不良结局相关的生物标志物。本研究旨在评估肌肉减少症与 LDLT 受者术后严重手术并发症的关系。这项回顾性研究纳入了 2005 年至 2017 年在我院接受 LDLT 的患者。使用横断面图像中的腰大肌指数（PMI）评估肌肉减少症。采用 ROC 曲线分析评估 PMI 预测术后并发症的能力。采用回归分析评估主要术后并发症与肌肉减少症之间的相关性。共纳入 271 例 LDLT 受者。男性患者的 PMI 与主要术后并发症之间无显著差异。发生主要术后并发症的女性受者的平均 PMI 值明显较低（P=0.028），且 PMI 截断值为 2.63cm/m。发生需要胸腔引流的大量胸腔积液的术后并发症在肌肉减少症组比非肌肉减少症组更常见（P=0.003）。肌肉减少症组（n=14）女性的 1、3、5 和 10 年总生存率明显低于非肌肉减少症组（n=108），分别为 92.9%比 97.2%、85.7%比 95.4%、85.7%比 92.5%和 70.1%比 82.0%（P=0.041），男性患者分别为 94.6%、89.9%、85.9%和 78.5%。肌肉减少症与女性术后严重并发症的风险显著增加相关。PMI 和肌肉减少症共同预测女性 LDLT 受者的术后严重并发症和生存率。
