Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan.
Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
J Thorac Cardiovasc Surg. 2022 Jul;164(1):300-311.e3. doi: 10.1016/j.jtcvs.2021.07.039. Epub 2021 Jul 30.
The study objective was to verify whether low preoperative radiographic density of erector spinae muscles is associated with poor prognosis after lung transplantation.
Preoperative chest computed tomography scans for patients who underwent deceased-donor lung transplantation between 2013 and 2019 at Kyoto University Hospital were retrospectively retrieved. The radiographic density of erector spinae muscles was quantitatively evaluated as the mean attenuation of erector spinae muscles, and low mean radiographic density of the erector spinae muscles was defined as a mean radiographic density of the erector spinae muscles value below the median value for all patients. Overall survival and chronic lung allograft dysfunction-free survival with high and low mean radiographic density of the erector spinae muscles were estimated using the Kaplan-Meier method and evaluated by the log-rank test, as well as by univariate and multivariate Cox proportional hazard analyses.
Of the 107 adult patients who underwent primary transplantation, 96 underwent at least 1 chest computed tomography scan within 24 hours before lung transplantation. The median mean radiographic density of the erector spinae muscles in these 96 patients was 49.2 Hounsfield units. A low mean radiographic density of the erector spinae muscles value was significantly associated with decreased overall survival (hazard ratio, 4.50; P = .030) and chronic lung allograft dysfunction-free survival (hazard ratio, 3.18; P = .028) in the multivariate analysis. Additionally, patients with preoperative steroid use and a low mean radiographic density of the erector spinae muscles value had a worse overall survival (P < .001) and chronic lung allograft dysfunction-free survival (P < .001) than patients with preoperative steroid use and a high mean radiographic density of the erector spinae muscles value and those without preoperative steroid use.
Low mean radiographic density of the erector spinae muscles was closely associated with a poor prognosis after lung transplantation. The prognosis was particularly poor in patients with preoperative steroid use and a low mean radiographic density of the erector spinae muscles. These results may be useful when considering the indications for lung transplantation or preoperative interventions. VIDEO ABSTRACT.
本研究旨在验证术前竖脊肌放射密度低是否与肺移植后预后不良相关。
回顾性检索了 2013 年至 2019 年期间在京都大学医院接受过已故供体肺移植的患者的术前胸部 CT 扫描。定量评估竖脊肌的放射密度作为竖脊肌的平均衰减，并将竖脊肌的低平均放射密度定义为所有患者的中位数以下的竖脊肌的平均放射密度值。使用 Kaplan-Meier 方法估计高和低竖脊肌平均放射密度的总生存率和慢性肺移植物功能障碍无生存时间，并通过对数秩检验以及单变量和多变量 Cox 比例风险分析进行评估。
在 107 例接受初次移植的成年患者中，96 例在肺移植前 24 小时内至少进行了 1 次胸部 CT 扫描。这 96 例患者的竖脊肌平均放射密度中位数为 49.2 亨氏单位。低竖脊肌平均放射密度值与总生存率降低显著相关（风险比，4.50；P=0.030）和慢性肺移植物功能障碍无生存时间（风险比，3.18；P=0.028）在多变量分析中。此外，与术前使用类固醇且竖脊肌平均放射密度值低的患者相比，术前使用类固醇且竖脊肌平均放射密度值高的患者和未使用类固醇的患者的总生存率（P<0.001）和慢性肺移植物功能障碍无生存时间（P<0.001）更差。
低竖脊肌平均放射密度与肺移植后预后不良密切相关。在术前使用类固醇且竖脊肌平均放射密度低的患者中，预后尤其差。这些结果在考虑肺移植的适应证或术前干预时可能有用。视频摘要。
