Chong Jazlyn, Guorgui Jacob, Coy Heidi, Ito Takahiro, Lu Michelle, DiNorcia Joseph, Agopian Vatche G, Farmer Douglas G, Raman Steven S, Busuttil Ronald W, Kaldas Fady M
Division of Liver and Pancreas Transplantation, Department of Surgery, The Dumont-UCLA Transplant Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California.
Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, California.
J Surg Res. 2022 Feb;270:386-393. doi: 10.1016/j.jss.2021.09.030. Epub 2021 Nov 2.
Frailty has been implicated as a negative predictor of Liver Transplant (LT) outcomes. However, an understanding of changes in patient muscle mass peri-LT, and their effect in high-acuity patients remains lacking. We examined the impact of perioperative muscle mass changes (ΔSMI) on high-acuity (MELD ≥35) LT recipients.
Skeletal muscle index (SMI) was calculated using CT imaging. Patients were divided into two groups, based on severity of peri-operative SMI decrease. LT recipients with chronic end-stage liver disease, MELD ≥35, and abdominal CT ≤30 days prior, and 30-90 days post LT were included. [1011 adult LT recipients reviewed, 2012-2018].
Of 1011 patients reviewed, 88 met inclusion criteria (median MELD 41.1). The median ΔSMI was -5.0 (-29.4 - +21.1 cm/m) (fig A). Patients were classified into two groups: ΔSMI<-5.0 (median ΔSMI: -0.4, n = 44) and ΔSMI>-5.0 (median ΔSMI: -9.2, n = 44). Recipients with ΔSMI<-5.0 had higher pre-LT SMI (35.4 versus 31.2 cm/m, P <0.001) and lower post-LT SMI (26.0 versus 30.8 cm/m, P <0.001). The ΔSMI<-5.0 group had higher early allograft dysfunction (40.9 versus 20.5%, P = 0.037), and inferior patient and graft survival (P = 0.015, 0.017, respectively). Multivariate analysis identified ΔSMI<-5.0 (HR: 2.938, P = 0.048), long cold-ischemia time (≥9h, HR: 7.332, P = 0.008), HCV (HR: 5.614, p = 0.001), and tracheostomy after LT (HR:9.218, P <0.001) as negative prognostic factors for patient survival .
Progressive perioperative sarcopenic deterioration was associated with inferior patient and graft survival in high acuity LT. These findings may guide pre and post-operative patient care and rehabilitation efforts in this challenging patient population.
衰弱被认为是肝移植（LT）预后的负面预测因素。然而，对于LT围手术期患者肌肉量的变化及其对重症患者的影响仍缺乏了解。我们研究了围手术期肌肉量变化（ΔSMI）对重症（终末期肝病模型评分≥35）LT受者的影响。
使用CT成像计算骨骼肌指数（SMI）。根据围手术期SMI降低的严重程度将患者分为两组。纳入患有慢性终末期肝病、终末期肝病模型评分≥35且术前30天内及LT术后30 - 90天内进行腹部CT检查的LT受者。[2012年至2018年共评估了1011例成年LT受者]。
在评估的1011例患者中，88例符合纳入标准（终末期肝病模型评分中位数为41.1）。ΔSMI的中位数为 - 5.0（-29.4 - +21.1 cm/m）（图A）。患者分为两组：ΔSMI < - 5.0（ΔSMI中位数：-0.4，n = 44）和ΔSMI > - 5.0（ΔSMI中位数：-9.2，n = 44）。ΔSMI < - 5.0的受者LT术前SMI较高（35.4对31.2 cm/m，P <0.001），LT术后SMI较低（26.0对30.8 cm/m，P <0.001）。ΔSMI < - 5.0组早期移植肝功能障碍发生率较高（40.9%对20.5%，P = 0.037），患者及移植物生存率较低（分别为P = 0.015、0.017）。多因素分析确定ΔSMI < - 5.0（风险比：2.938，P = 0.048）、长冷缺血时间（≥9小时，风险比：7.332，P = 0.008）、丙型肝炎病毒感染（风险比：5.614，P = 0.001）以及LT术后气管切开（风险比：9.218，P <0.001）是患者生存的负面预后因素。
围手术期进行性肌肉减少性恶化与重症LT患者及移植物生存率较低相关。这些发现可能为这一具有挑战性的患者群体的术前和术后患者护理及康复工作提供指导。
