Zhejiang University, School of Medicine.
Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health.
Int J Surg. 2024 Jun 1;110(6):3543-3553. doi: 10.1097/JS9.0000000000001303.
Split liver transplantation (SLT) increases graft availability, but it's safe and effective utilization is insufficiently documented. This study aimed to investigate the association between perioperative body composition abnormalities and outcomes in adult SLT.
Two hundred forty recipients who underwent SLT in three centers were enrolled in this retrospective cohort study. Body composition abnormalities including sarcopenia, myosteatosis, visceral obesity, and sarcopenic obesity were evaluated at baseline and 1 month after surgery using computed tomography. Their impact on outcomes including early allograft dysfunction, early complications, ICU stay, graft regeneration rate, and survival was analyzed.
Recipients with sarcopenia or myosteatosis had a higher risk of early allograft dysfunction, higher early complication rate, and longer length of ICU stay (all P <0.05), while there was no difference in graft regeneration rate. Recipient and graft survival were significantly worse for recipients with body composition abnormalities (all P <0.05). In multivariable Cox-regression analysis, sarcopenia [hazard ratio (HR)=1.765, P =0.015], myosteatosis (HR=2.066, P =0.002), and visceral obesity (HR=1.863, P =0.008) were independently associated with shorter overall survival. Piling up of the three factors increased the mortality risk stepwise ( P <0.001). Recipients experienced skeletal muscle loss and muscle fat infiltration 1 month after surgery. Postoperative worsening sarcopenia (HR=2.359, P =0.009) and myosteatosis (HR=1.878, P =0.026) were also identified as independent risk factors for mortality.
Sarcopenia, myosteatosis, and their progression negatively affect outcomes including early allograft dysfunction, early complications, ICU stay and survival after SLT. Systemic evaluation and dynamic monitoring of body composition are valuable.
劈离式肝移植（SLT）增加了供体的可用性，但它的安全有效利用尚未得到充分记录。本研究旨在探讨成人 SLT 围手术期身体成分异常与结局的关系。
本回顾性队列研究纳入了在三个中心接受 SLT 的 240 例受者。使用计算机断层扫描（CT）在基线和术后 1 个月评估身体成分异常，包括肌肉减少症、肌内脂肪增多、内脏肥胖和肌肉减少性肥胖。分析它们对包括早期移植物功能障碍、早期并发症、重症监护病房（ICU）入住时间、移植物再生率和存活率等结局的影响。
存在肌肉减少症或肌内脂肪增多的受者，早期移植物功能障碍的风险更高，早期并发症发生率更高，ICU 入住时间更长（均 P <0.05），但移植物再生率无差异。存在身体成分异常的受者，受者和移植物存活率明显更差（均 P <0.05）。多变量 Cox 回归分析显示，肌肉减少症（危险比 [HR]=1.765，P =0.015）、肌内脂肪增多（HR=2.066，P =0.002）和内脏肥胖（HR=1.863，P =0.008）与总生存时间缩短独立相关。这三种因素的累积增加了死亡率的递增风险（P <0.001）。受者术后 1 个月经历了骨骼肌丢失和肌肉脂肪浸润。术后恶化的肌肉减少症（HR=2.359，P =0.009）和肌内脂肪增多（HR=1.878，P =0.026）也被确定为死亡的独立危险因素。
肌肉减少症、肌内脂肪增多及其进展对 SLT 后早期移植物功能障碍、早期并发症、ICU 入住时间和存活率等结局产生负面影响。全身评估和身体成分的动态监测具有重要价值。
