The role of recipient myosteatosis in graft and patient survival after deceased donor liver transplantation

被引:37
作者
Czigany, Zoltan [1 ]
Kramp, Wiebke [1 ]
Lurje, Isabella [1 ,5 ]
Miller, Hannah [1 ,6 ]
Bednarsch, Jan [1 ]
Lang, Sven Arke [1 ]
Ulmer, Tom Florian [1 ]
Bruners, Philipp [2 ]
Strnad, Pavel [3 ]
Trautwein, Christian [3 ]
von Websky, Martin Wolfgang [4 ]
Tacke, Frank [3 ,5 ]
Neumann, Ulf Peter [1 ,7 ]
Lurje, Georg [1 ,6 ]
机构
[1] Univ Hosp RWTH Aachen, Dept Surg & Transplantat, Aachen, Germany
[2] Univ Hosp RWTH Aachen, Inst Radiol, Aachen, Germany
[3] Univ Hosp RWTH Aachen, Dept Internal Med 3, Aachen, Germany
[4] Univ Hosp Bonn, Dept Surg, Bonn, Germany
[5] Charite Univ Med Berlin, Campus Virchow Klinikum, Campus Charite Mitte, Dept Hepatol & Gastroenterol, Berlin, Germany
[6] Charite Univ Med Berlin, Campus Virchow Klinikum, Campus Charite Mitte, Dept Surg, Augustenburger Pl 1, D-13353 Berlin, Germany
[7] Maastricht Univ, Med Ctr MUMC, Dept Surg, Maastricht, Netherlands
关键词
Liver transplantation; Body composition; Myosteatosis; Sarcopenia; Graft survival; Patient survival;
D O I
10.1002/jcsm.12669
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Background Myosteatosis is associated with perioperative outcomes in orthotopic liver transplantation (OLT). Here, we investigated the effects of body composition and myosteatosis on long-term graft and patient survival following OLT. Methods Clinical data from 225 consecutive OLT recipients from a prospective database were retrospectively analysed (May 2010 to December 2017). Computed tomography-based lumbar skeletal muscle index (SMI) (muscle mass) and mean skeletal muscle radiation attenuation (SM-RA) (myosteatosis) were calculated using a segmentation tool (3D Slicer). Patients with low skeletal muscle mass (low SMI) and myosteatosis (low SM-RA) were identified using predefined and validated cut-off values. Results The mean donor and recipient age was 55 +/- 16 and 54 +/- 12 years, respectively. Some 67% of the recipients were male. The probability of graft and patient survival was significantly lower in patients with myosteatosis compared with patients with higher SM-RA values (P = 0.011 and P = 0.001, respectively). Low skeletal muscle mass alone was not associated with graft and patient survival (P = 0.273 and P = 0.278, respectively). Dividing the cohort into quartiles, based on the values of SMI and SM-RA, resulted in significant differences in patient but not in graft survival (P = 0.011). Even though multivariable analysis identified low SM-RA as an important prognostic marker (hazard ratio: 2.260, 95% confidence interval: 1.177-4.340, P = 0.014), myosteatosis lost its significance when early mortality (90 days) was excluded from the final multivariable model. Patients with myosteatosis showed significantly higher all-cause mortality and in particular higher rates of deaths due to respiratory and septic complication (P = 0.002, P = 0.022, and P = 0.049, respectively). Conclusion Preoperative myosteatosis may be an important prognostic marker in patients undergoing deceased donor liver transplantation. The prognostic value of myosteatosis seems to be particularly important in the early post-operative phase. Validation in prospective clinical trials is warranted.
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收藏
页码:358 / 367
页数:10
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