Tan Yifei, Duan Ting, Li Bo, Zhang Bohan, Zhu Yunfeng, Yan Ke, Song Jiulin, Lv Tao, Yang Jian, Jiang Li, Yang Jiayin, Wen Tianfu, Yan Lunan
Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
Quant Imaging Med Surg. 2022 Jan;12(1):215-228. doi: 10.21037/qims-21-314.
The effect of sarcopenia on long-term outcomes in recipients after living donor liver transplantation (LDLT), including overall survival and hepatocellular carcinoma (HCC) recurrence, remains unclear, especially in China.
From 2009 to 2015, 117 adult patients underwent LDLT in our center. In all, 82 patients who had computed tomography images reaching the third lumbar vertebra level within 1 month of LDLT were included; 70 male patients were included in the final analysis after excluding 12 female patients because of poor performance of the calculated cutoff value. Sarcopenia was defined according to the psoas muscle index (PMI) cutoff value, which was calculated based on dynamic time-dependent outcomes using X-tile software. Cox proportional hazards models were used to assess multivariate-adjusted hazards ratios (HRs) to seek potential correlations between sarcopenia and posttransplant outcomes.
According to the cutoff value of PMI (6.25 cm/m), 38 patients (54.3%) were diagnosed with sarcopenia. After an average of 63.3 months of follow-up, 21 patients died after LDLT, 16 in the sarcopenia group and 5 in the non-sarcopenia group, respectively. Sarcopenia was identified as being significantly associated with worse posttransplant overall survival in multivariate analysis, resulting in an HR of 3.22 [95% confidence interval (CI), 1.15-8.98]. Among the 50 recipients with HCC, sarcopenia was significantly associated with HCC recurrence in univariate analysis (HR 2.87, 95% CI, 1.06-7.80) but was not detected as an independent risk factor of HCC recurrence in multivariate analysis, although a trend (tendency)towards significance was observed (HR 2.60, 95% CI, 0.95-7.10; P=0.062).
Sarcopenia defined by PMI is a feasible and reliable independent predictor of posttransplant overall survival in male LDLT candidates. However, its correlation with posttransplant HCC recurrence remains uncertain.
肌肉减少症对活体肝移植（LDLT）受者长期预后的影响，包括总生存率和肝细胞癌（HCC）复发情况，仍不明确，在中国尤其如此。
2009年至2015年，117例成年患者在本中心接受了LDLT。总共纳入了82例在LDLT后1个月内有达到第三腰椎水平的计算机断层扫描图像的患者；在排除12例因计算的临界值表现不佳的女性患者后，最终分析纳入了70例男性患者。肌肉减少症根据腰大肌指数（PMI）临界值定义，该临界值使用X-tile软件基于动态时间依赖性结果进行计算。使用Cox比例风险模型评估多变量调整后的风险比（HR），以寻找肌肉减少症与移植后结局之间的潜在相关性。
根据PMI临界值（6.25 cm/m），38例患者（54.3%）被诊断为肌肉减少症。平均随访63.3个月后，21例患者在LDLT后死亡，肌肉减少症组16例，非肌肉减少症组5例。在多变量分析中，肌肉减少症被确定与移植后较差的总生存率显著相关，HR为3.22[95%置信区间（CI），1.15 - 8.98]。在50例HCC受者中，肌肉减少症在单变量分析中与HCC复发显著相关（HR 2.87，95%CI，1.06 - 7.80），但在多变量分析中未被检测为HCC复发的独立危险因素，尽管观察到有显著趋势（HR 2.60，95%CI，0.95 - 7.10；P = 0.062）。
由PMI定义的肌肉减少症是男性LDLT候选者移植后总生存率的可行且可靠的独立预测指标。然而，其与移植后HCC复发的相关性仍不确定。
