Varkey Julie, Mehlig Kirsten, Bajor Antal, Khalil Shilla, Oltean Mihai, Gäbel Markus, Bennet William, Varkey Jonas
Department of Endodontology, Institute of Odontology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
Clin Nutr ESPEN. 2025 Aug;68:410-416. doi: 10.1016/j.clnesp.2025.05.035. Epub 2025 May 24.
Intestinal transplantation (ITX) is a life-saving treatment for patients with irreversible intestinal failure. While short-term survival has improved, long-term outcomes remain challenging, and the role of Low Muscle Mass (LMM) in influencing post-transplant outcomes is unclear. This study investigates the prevalence and impact of LMM on long-term survival in adults who underwent ITX, while also examining the longitudinal changes in body composition following transplantation.
This retrospective study included 26 adult patients who underwent ITX from February 2000 to August 2023. Body composition was assessed using Dual-Energy X-ray Absorptiometry (DEXA) scans, focusing on appendicular skeletal muscle mass index (ASMI) as an indicator of LMM. Longitudinal changes in ASMI, body fat percentage, body mass index (BMI), and bone mineral density (BMD) were analyzed using mixed linear regression models. Survival analysis was conducted using Kaplan-Meier curves and Cox proportional hazards regression.
Pre-transplant LMM was prevalent in 58 % of patients. Patients with LMM were younger (34 years vs. 49 years, p = 0.001), with lower BMI (18.8 vs. 23.4, p = 0.003) and ASMI (5.1 vs. 6.8, p = 0.0003). Over up to 10 years of follow-up, average ASMI change was 0.02 kg/m/year (-0.06, 0.10), showing positive time trends in patients younger than 40 years and negative trends in older patients (interaction p = 0.04). A similar age dependence was seen for BMD (interaction p = 0.01). ASMI, BMI, and fat percentage increased from pre-TX to the most recent follow-up, but these changes were not significantly different from zero. Additionally, 5-year mortality and overall survival rates did not significantly differ by pre-TX LMM status.
Pre-TX LMM is common in ITX patients but does not significantly impact long-term survival or body composition post-transplant. Thus, LMM alone may not be a contraindication for ITX, and muscle mass remained relatively stable over the follow-up period.
肠道移植（ITX）是治疗不可逆肠衰竭患者的一种挽救生命的疗法。虽然短期生存率有所提高，但长期预后仍然具有挑战性，低肌肉量（LMM）对移植后预后的影响尚不清楚。本研究调查了LMM在接受ITX的成年患者中的患病率及其对长期生存的影响，同时还研究了移植后身体成分的纵向变化。
这项回顾性研究纳入了2000年2月至2023年8月期间接受ITX的26例成年患者。使用双能X线吸收法（DEXA）扫描评估身体成分，重点关注四肢骨骼肌质量指数（ASMI）作为LMM的指标。使用混合线性回归模型分析ASMI、体脂百分比、体重指数（BMI）和骨密度（BMD）的纵向变化。使用Kaplan-Meier曲线和Cox比例风险回归进行生存分析。
移植前LMM在58%的患者中普遍存在。LMM患者更年轻（34岁对49岁，p = 0.001），BMI更低（18.8对23.4，p = 0.003），ASMI更低（5.1对6.8，p = 0.0003）。在长达10年的随访中，平均ASMI变化为0.02 kg/m/年（-0.06，0.10），40岁以下患者呈正时间趋势，老年患者呈负时间趋势（交互作用p = 0.04）。BMD也观察到类似的年龄依赖性（交互作用p = 0.01）。从移植前到最近一次随访，ASMI、BMI和脂肪百分比均有所增加，但这些变化与零无显著差异。此外，移植前LMM状态对5年死亡率和总生存率无显著差异。
移植前LMM在ITX患者中很常见，但对移植后的长期生存或身体成分没有显著影响。因此，仅LMM可能不是ITX的禁忌症，并且在随访期间肌肉量保持相对稳定。
