■肝移植(LT)是肝硬化的游戏规则改变者。定义为肌肉减少症的肌肉质量差可能会破坏LT记分板。
■评估在接受LT的印度患者中,少肌症的患病率和对术中和术后早期结果的影响。
■预LT,分析了115例LT受者L3椎骨的单层常规计算机断层扫描图像,以获得以m2为单位的高度归一化的六个骨骼肌的横截面积-骨骼肌指数(SMI;cm2/m2)。男性SMI<52.4,女性<38.5,称为肌少症。术中,我们比较了骨肉和非骨肉的术后结局参数和90日死亡率.
■在47.8%的患者中发现了肌肉减少症[M(90.4%);年龄,46.3±10;BMI,24.5±4.3kg/m2;儿童A:B:C=1%:22%:77%;MELD,20.6±6.3;病因酒精:nonalchohol=53%:47%;Charlson合并症指数(CCI)>3:≤3=56.5%:43.5%]。肌肉与非肌肉;术后早期并发症:[脓毒症,49(89%)与33(55%),P=0.001;神经系统并发症,16(29.6%)与5(8.8%),P=0.040;Clavien-Dindo分类≥3-24(43.6%):15(25.4%),P=0.041;辅助参数(天),通气时间[中位数(范围)]1.5(1-3)与1(1-2)P=0.021;重症监护病房(ICU)住院12(8-16)与10(8-12)P=0.024;步行时间9(7-11)与6(5-7)P=0.001;排水去除18.7±7.3vs.14.4±6.2,P=0.001;需要气管造口术5(9%)与0(%),P=0.017;术前急性肾损伤患病率,合并症和透析要求,术中失血量和肌动蛋白支持明显较高。90天死亡率在5种(9.09%)和非5种(6.6%)之间相当,P=0.63。SMI(OR:0.83;95%CI:0.71-0.97,P=0.016;慢性急性肝衰竭(ACLF)表现12.5(1.65-95.2),P=0.015,术中出血量3.74(0.96-14.6),P=0.046是90天死亡率的预测因子。
■几乎50%的LT接受者患有肌少症,术后败血症的发生率较高,神经系统并发症,延长ICU住院时间和通气支持。低SMI,ACLF演示文稿,术中失血是早期死亡率的独立预测因素。
UNASSIGNED: Liver transplantation (LT) is a game changer in cirrhosis. Poor muscle mass defined as sarcopenia may potentially upset the LT scoreboard.
UNASSIGNED: To assess the prevalence and impact of sarcopenia on the intraoperative and early postoperative outcomes in Indian patients undergoing LT.
UNASSIGNED: Pre LT, single-slice routine computed tomography images at L3 vertebra of 115 LT recipients were analyzed, to obtain cross-sectional area of six skeletal muscles normalized for height in m2 - skeletal muscle index (SMI; cm2/m2). SMI< 52.4 in males and <38.5 in females was called sarcopenia. The intraoperative, postoperative outcome parameters and 90-day mortality were compared between sarcopenics and nonsarcopenics.
UNASSIGNED: Sarcopenia was found in 47.8% of patients [M (90.4%); age, 46.3 ± 10; BMI, 24.5 ± 4.3 kg/m2; child A:B:C = 1%:22%:77%; MELD, 20.6 ± 6.3; etiology alcohol: nonalchohol = 53%:47%; Charlson Comorbidity Index (CCI) > 3:≤3 = 56.5%:43.5%]. Sarcopenics vs. Nonsarcopenics; early postoperative complications: [sepsis, 49(89%) vs. 33(55%), P = 0.001; neurologic complications, 16(29.6%) vs. 5(8.8%), P = 0.040; Clavien-Dindo Classification ≥3-24 (43.6%):15 (25.4%),P = 0.041; ancillary parameters (days), duration of ventilation [median (range)] 1.5(1-3) vs. 1 (1-2), P = 0.021; intensive care unit (ICU) stay 12 (8-16) vs. 10 (8-12), P = 0.024; time to ambulation 9 (7-11) vs. 6 (5-7), P = 0.001; drain removal 18.7 ± 7.3 vs. 14.4 ± 6.2, P = 0.001; need for tracheostomy 5 (9%) vs. 0 (%), P = 0.017; preoperative prevalence of acute kidney injury, comorbidities and requirement for dialysis, intraoperative blood loss & inotropic support were significantly higher in sarcopenics. Ninety-day mortality was comparable between sarcopenics 5 (9.09%) and nonsarcopenics 4 (6.6%) P = 0.63. SMI (OR: 0.83; 95% CI: 0.71-0.97, P = 0.016; Acute on chronic liver failure (ACLF) presentation 12.5 (1.65-95.2), P = 0.015 and intraoperative blood loss 3.74 (0.96-14.6), P = 0.046 were predictors of 90-day mortality.
UNASSIGNED: Almost 50% of LT recipients had sarcopenia, who had a higher incidence of postoperative sepsis, neurological complications, longer ICU stay and ventilatory support. Low SMI, ACLF presentation, and intraoperative blood loss were the independent predictors of early mortality.