Kyrana Eirini, Williams Jane E, Wells Jonathan C, Dhawan Anil
From the King's College Hospital NHS Foundation Trust and MowatLabs, London, United Kingdom.
MRC Childhood Nutrition Research Centre, Institute of Child Health, London, United Kingdom.
JPGN Rep. 2022 Apr 8;3(2):e200. doi: 10.1097/PG9.0000000000000200. eCollection 2022 May.
In adults, weight loss and sarcopenia are prognostic indicators of poor outcomes for patients awaiting liver transplant (LT). We tested the hypothesis that sarcopenia in children awaiting LT was related to poor outcomes.
Children with end-stage chronic liver disease undergoing assessment for LT were recruited into an observational longitudinal study. Anthropometry and body composition (BC; whole-body dual-energy x-ray absorptiometry scan) were assessed before and, on average, 1 year after LT.
Eleven children (6 females:5 males) were assessed (4.7 to 17.2 years; median, 9.9) at baseline. Nine children went on to have an LT. The aspartate aminotransferase-to-platelet ratio index had a significant positive correlation with trunk lean mass and trunk lean mass index (LMI) SD score (SDS). At baseline, 4 patients were sarcopenic with appendicular LMI SDS less than -1.96. All fat mass and fat mass index (FMI) SDSs were within the normal range (above -1.96). There was a strong negative correlation between FMI SDS and height SDS. After transplant, there was a significant reduction in trunk LMI from 1.20 to -0.51 (95% CI, 1.03-2.4; < 0.01). Body mass index SDS had a negative correlation with days to discharge after transplant. The majority of patients discharged after 16 days were sarcopenic. One year after transplantation, all patients were alive with normal graft function regardless of BC before LT.
FMIs were normal regardless of LMIs and correlated negatively with height. BC was related to days to discharge after LT but not to outcomes a year after LT.
在成人中，体重减轻和肌肉减少症是等待肝移植（LT）患者预后不良的指标。我们检验了等待LT的儿童肌肉减少症与预后不良相关的假设。
将接受LT评估的终末期慢性肝病儿童纳入一项观察性纵向研究。在LT前及平均LT后1年评估人体测量学指标和身体成分（BC；全身双能X线吸收法扫描）。
11名儿童（6名女性：5名男性）在基线时接受评估（4.7至17.2岁；中位数9.9岁）。9名儿童接受了LT。天冬氨酸转氨酶与血小板比值指数与躯干瘦体重和躯干瘦体重指数（LMI）标准差评分（SDS）呈显著正相关。基线时，4例患者存在肌肉减少症，其四肢LMI SDS低于-1.96。所有脂肪量和脂肪量指数（FMI）SDS均在正常范围内（高于-1.96）。FMI SDS与身高SDS之间存在强烈负相关。移植后，躯干LMI从1.20显著降至-0.51（95%CI，1.03 - 2.4；P < 0.01）。体重指数SDS与移植后出院天数呈负相关。大多数在16天后出院的患者存在肌肉减少症。移植1年后，所有患者均存活，移植肝功能正常，无论LT前的BC如何。
无论LMI如何，FMI均正常，且与身高呈负相关。BC与LT后出院天数相关，但与LT后1年的预后无关。
