Hu Ashley, Prosper Ashley, Ruchalski Kathleen, Fulinara Christian, Huynh Alina, Sayah David, Weigt Stephen S, Singer Jonathan, Ardehali Abbas, Biniwale Reshma, Goldwater Deena, Schaenman Joanna
Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California.
Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California.
Ann Thorac Surg Short Rep. 2022 Nov 9;1(1):174-178. doi: 10.1016/j.atssr.2022.11.005. eCollection 2023 Mar.
As lung transplantation (LT) expands to older recipients, objective approaches to evaluate the aging are needed to optimize posttransplantation outcomes. Frailty assessment and sarcopenia have shown promise as tools for predicting clinical outcomes.
Patients older than 55 years undergoing evaluation for LT were enrolled in an institutional review board-approved study. Sarcopenia was measured on pretransplantation chest computed tomography images, measuring cross-sectional area and average attenuation of the pectoralis major muscle at 1 slice above the aortic arch. Frailty was measured using the Fried frailty phenotype (FFP) and Short Performance Physical Battery (SPPB).
The study evaluated 84 patients with results of computed tomography of the chest available for review; 63% were classified as frail or prefrail by SPPB and 53% were frail by FFP. Sex-corrected sarcopenia was associated with frailty by FFP ( = .004) or SPPB ( = .044). Sarcopenia, measured by area or average attenuation, was significantly associated with length of stay after transplantation ( = .017 and = .022, respectively), with a median 12 days for those with higher muscle mass compared with 21 days for those with lower muscle mass. Total time in the hospital in the first year after transplantation was also associated with sarcopenia by area ( = .090) or average attenuation ( = .046).
A multifaceted approach to the evaluation of older patients can improve risk stratification, optimizing organ allocation to improve LT outcomes.
随着肺移植（LT）扩展至年龄更大的受者，需要客观的方法来评估衰老情况，以优化移植后的结果。衰弱评估和肌肉减少症已显示出作为预测临床结果工具的前景。
对年龄超过55岁且正在接受LT评估的患者进行了一项经机构审查委员会批准的研究。在移植前胸部计算机断层扫描图像上测量肌肉减少症，测量主动脉弓上方1层的胸大肌横截面积和平均衰减。使用弗里德衰弱表型（FFP）和简短体能状况量表（SPPB）测量衰弱情况。
该研究评估了84例有胸部计算机断层扫描结果可供审查的患者；63%被SPPB分类为衰弱或衰弱前期，53%被FFP分类为衰弱。经性别校正的肌肉减少症与FFP（P = .004）或SPPB（P = .044）所定义的衰弱相关。通过面积或平均衰减测量的肌肉减少症与移植后住院时间显著相关（分别为P = .017和P = .022），肌肉质量较高者的中位数为12天，而肌肉质量较低者为21天。移植后第一年的总住院时间也与按面积（P = .090）或平均衰减（P = .046）测量的肌肉减少症相关。
对老年患者进行多方面评估可改善风险分层，优化器官分配以改善LT结果。
