Kim Jae Hwan, Kim Yeon Ju, Kwon Hye-Mee, Kim Kyung-Won, YanZhen Jin, Kang Sa-Jin, Jun In-Gu, Song Jun-Gol, Hwang Gyu-Sam
Department of Anesthesiology and Pain Medicine, Inje University Haeundae Paik Hospital, Busan 48108, Republic of Korea.
Laboratory for Cardiovascular Dynamics, Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Seoul 05505, Republic of Korea.
J Clin Med. 2025 Aug 20;14(16):5889. doi: 10.3390/jcm14165889.
Preoperative sarcopenia in liver transplantation (LT) recipients is an important prognostic factor of LT outcomes. Systemic inflammatory status (SIS) has been proposed as a unifying mechanism for skeletal muscle loss; thus, considering SIS and sarcopenia together may enhance prognosis assessment in patients undergoing LT. Herein, we aimed to describe the relationship between the SIS and skeletal muscle index (SMI) with short-term and long-term mortality post-living donor LT (LDLT). In total, 3387 consecutive adult LDLT recipients were retrospectively evaluated. The neutrophil-to-lymphocyte ratio (NLR, using a cut-off of 3) was utilized as an SIS. SMI was calculated using computed tomography scans, measured at the third lumbar vertebra; sex-specific cut-offs were determined from contemporary donors. Univariate and multivariable Cox proportional hazard analyses were performed. Decreasing SMI was associated with increasing NLR. Increasing NLR and decreasing SMI both showed dose-dependent relationships with a risk of 90-day mortality. Within sarcopenic patients, NLR > 3 (vs. NLR ≤ 3) was associated with higher 90-day (9.3% vs. 3.5%, = 0.049) and overall mortality (28.4% vs. 19.1%, = 0.045). Sarcopenia and NLR > 3 (vs. neither) were independent predictors of 90-day mortality (hazard ratio [HR] 2.48 [1.40-4.40], = 0.002) and overall mortality (HR, 1.81 [1.37-2.38], < 0.001) after multivariable adjustment. When stratified by age, sex, and MELD score, the association between sarcopenia and overall mortality persisted in all subgroups, with the highest risk observed in women (HR 3.43, 95% CI 1.83-6.43). Sarcopenia, with the systemic inflammatory response, nearly doubled the risk of 90-day and overall mortality post-LT, proposing that these readily available biomarkers are a practical index for predicting survival post-LT. Considering that these are potentially modifiable factors, our result may provide a new therapeutic target to improve survival post-LT.
肝移植（LT）受者术前的肌肉减少症是肝移植预后的重要预测因素。全身炎症状态（SIS）被认为是骨骼肌丢失的统一机制；因此，综合考虑SIS和肌肉减少症可能会提高肝移植患者的预后评估。在此，我们旨在描述活体肝移植（LDLT）后短期和长期死亡率与SIS和骨骼肌指数（SMI）之间的关系。总共对3387例连续的成年LDLT受者进行了回顾性评估。中性粒细胞与淋巴细胞比值（NLR，临界值为3）被用作SIS指标。SMI通过计算机断层扫描计算得出，在第三腰椎水平测量；根据当代供体确定了性别特异性临界值。进行了单因素和多因素Cox比例风险分析。SMI降低与NLR升高相关。NLR升高和SMI降低均与90天死亡率风险呈剂量依赖性关系。在肌肉减少症患者中，NLR>3（vs.NLR≤3）与更高的90天死亡率（9.3% vs.3.5%，P = 0.049）和总死亡率（28.4% vs.19.1%，P = 0.045）相关。多因素调整后，肌肉减少症和NLR>3（vs.两者均无）是90天死亡率（风险比[HR]2.48[1.40 - 4.40]，P = 0.002）和总死亡率（HR，1.81[1.37 - 2.38]，P < 0.001）的独立预测因素。按年龄、性别和终末期肝病模型（MELD）评分分层时，肌肉减少症与总死亡率之间的关联在所有亚组中均持续存在，女性的风险最高（HR 3.43，95%可信区间1.83 - 6.43）。肌肉减少症与全身炎症反应一起，使肝移植后90天和总死亡率的风险几乎增加一倍，这表明这些易于获得的生物标志物是预测肝移植后生存的实用指标。鉴于这些是潜在可改变的因素，我们的结果可能为改善肝移植后生存提供一个新的治疗靶点。
