Sarcopenia and mortality after liver transplantation.
Sarcopenia and mortality after liver transplantation.
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DOI：
10.1016/j.jamcollsurg.2010.03.039
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发表时间：
2010-08
影响因子：
5.2
通讯作者：
Sonnenday, Christopher J.
中科院分区：
文献类型：
--
作者：
Englesbe, Michael J.;Patel, Shaun P.;He, Kevin;Lynch, Raymond J.;Schaubel, Douglas E.;Harbaugh, Calista;Holcombe, Sven A.;Wang, Stewart C.;Segev, Dorry L.;Sonnenday, Christopher J.
外科医生常常难以确定患者是否适合肝移植。客观和全面的疾病负担测量，如肌肉减少症，可以告知临床医生并帮助避免无效的移植。对163例肝移植受者的腰肌横截面积进行了CT扫描测量。在使用Cox回归模型控制供体和受体特征后，我们描述了腰肌面积与移植后死亡率之间的关系。腰大肌面积与MELD评分和血清白蛋白相关性较差。Cox回归显示腰肌面积与移植后死亡率之间有很强的相关性（HR=3.7 / 1000 mm2腰肌面积减少（p<0.0001））。根据腰大肌面积（保持供体和受体特征不变）分层后，一年生存率从腰大肌面积最小的四分位数的49.7%到最大的四分位数的87.0%不等。3年生存率分别为26.4%和77.2%。在这些模型中，腰肌面积对生存率的影响超过了所有其他协变量。中枢性肌肉减少症与肝移植后死亡率密切相关。这种对患者虚弱的客观测量，如肌肉减少症，可以为临床决策和潜在的分配政策提供信息。需要进一步的工作来制定有效的和临床相关的肝移植中肌肉减少和虚弱的措施。
Surgeons frequently struggle to determine patient suitability for liver transplantation. Objective and comprehensive measures of overall burden of disease, such as sarcopenia, could inform clinicians and help avoid futile transplants. The cross sectional area of the psoas muscle was measured on CT scans of 163 liver transplant recipients. After controlling for donor and recipient characteristics using Cox regression models, we described the relationship between psoas area and post-transplant mortality. Psoas area correlated poorly with MELD score and serum albumin. Cox regression revealed a strong association between psoas area and post-transplant mortality (HR=3.7 per 1000 mm2 decrease in psoas area (p<0.0001). Upon stratification into quartiles based on psoas area (holding donor and recipient characteristics constant), one year survival ranged from 49.7% for the quartile with the smallest psoas area to 87.0% for the quartile with the largest. Survival at three years among these groups was 26.4% and 77.2%, respectively. The impact of psoas area on survival exceeded that all other covariates in these models. Central sarcopenia strongly correlates with post-liver transplant mortality. Such objective measures of patient frailty such as sarcopenia may inform clinical decision making and potentially allocation policy. Further work is needed develop valid and clinically relevant measures of sarcopenia and frailty in liver transplantation.
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