移植前肌肉减少症对肝移植受者死亡率的影响。

Effect of Pretransplant Sarcopenia on Mortality in Liver Transplant Recipients.

作者信息

Arı Derya, Dağlı Mustafa, Gökcan Hale, Turan Gökçe Dilara, Ökten Rıza Sarper, Aydın Osman, Kaçar Sabite, Bostancı Erdal Birol, Akdoğan Kayhan Meral

机构信息

From the Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey.

出版信息

Exp Clin Transplant. 2023 Feb;21(2):123-131. doi: 10.6002/ect.2022.0344.

DOI:10.6002/ect.2022.0344

PMID:36919720

Abstract

OBJECTIVES

Sarcopenia is an important metabolic disorder associated with end-stage liver disease and is an independent predictor of mortality in liver transplant candidates. We evaluated effects of pretransplant muscle mass, muscle quality, and visceral adipose tissue on mortality after liver transplant.

MATERIALS AND METHODS

For 2015-2020, we included 65 liver transplant recipients whose records contained pretransplant liver computed tomography images. We calculated skeletal muscle mass index (muscle tissue area in centimeters squared divided by height in meters squared), visceral-to-subcutaneous fat ratio (visceral adiposity indicator), and intramuscular adipose tissue content ratio (muscle quality indicator).

RESULTS

Median age was 55 years (IQR, 45-63 years), and 48 (73.8%) patients were men. During follow-up, 53 (81.5%) study group patients survived; mean survival time was 71.73 ± 3.81 months. The deceased patient group had a statistically higher pretransplant visceral-to-subcutaneous fat ratio than the survival group (P = .046). Survival was 100% for 1 positive indicator, 86.2% for 2 positive indicators, and 70.4% for 3 positive indicators (P = .096). Positive correlation was confirmed between pretransplant skeletal muscle mass index and age (P = .043) and pretransplant body mass index (weight in kilograms divided by height in meters squared) (P < .001). There was a moderate positive correlation between pretransplant intramuscular adipose tissue content ratio and age (R = 0.529, P ≤ .001) and a weak positive correlation with pretransplant body mass index (R = 0.361, P = .003). Furthermore, pretransplant visceral- tosubcutaneous fat ratio showed a weak positive correlation with age (R = 0.306, P = .013) and a weak negative correlation with the Model for End-Stage Liver Disease score (R = -0.301, P = .016).

CONCLUSIONS

Pretransplant sarcopenia is an important indicator to predict mortality and morbidity in posttransplant follow-up. Visceral-to-subcutaneous fat ratio is an important parameter to evaluate sarcopenia in liver transplant patients.

摘要

目的

肌肉减少症是一种与终末期肝病相关的重要代谢紊乱，是肝移植候选者死亡率的独立预测因素。我们评估了移植前肌肉质量、肌肉质量和内脏脂肪组织对肝移植后死亡率的影响。

材料与方法

在2015年至2020年期间，我们纳入了65名肝移植受者，其记录包含移植前肝脏计算机断层扫描图像。我们计算了骨骼肌质量指数（以平方厘米为单位的肌肉组织面积除以以米为单位的身高的平方）、内脏与皮下脂肪比率（内脏肥胖指标）和肌肉内脂肪组织含量比率（肌肉质量指标）。

结果

中位年龄为55岁（四分位间距，45 - 63岁），48名（73.8%）患者为男性。在随访期间，53名（81.5%）研究组患者存活；平均生存时间为71.73±3.81个月。死亡患者组移植前的内脏与皮下脂肪比率在统计学上高于存活组（P = 0.046）。1个阳性指标的患者生存率为100%，2个阳性指标的患者生存率为86.2%，3个阳性指标的患者生存率为70.4%（P = 0.096）。移植前骨骼肌质量指数与年龄（P = 0.043）和移植前体重指数（以千克为单位的体重除以以米为单位的身高的平方）（P < 0.001）之间存在正相关。移植前肌肉内脂肪组织含量比率与年龄之间存在中度正相关（R = 0.529，P≤0.001），与移植前体重指数之间存在弱正相关（R = 0.361，P = 0.003）。此外，移植前内脏与皮下脂肪比率与年龄之间存在弱正相关（R = 0.306，P = 0.013），与终末期肝病模型评分之间存在弱负相关（R = -0.301，P = 0.016）。