生体肝移植患者の生存とサルコペニア

生体肝移植患者の生存に対するサルコペニアの影響に関する論文を紹介します。

Kaido T, Ogawa K, Fujimoto Y, Ogura Y, Hata K, Ito T, Tomiyama K, Yagi S, Mori A, Uemoto S. Impact of Sarcopenia on Survival in Patients Undergoing Living Donor Liver Transplantation. Am J Transplant. 2013 Apr 19. doi: 10.1111/ajt.12221. [Epub ahead of print]

対象は生体肝移植を行った成人患者124人です。サルコペニアは体成分分析（インピーダンス）で評価しました。結果ですが、術前の骨格筋量の割合は、標準値と比較して中央値92%（67-130%）でした。

骨格筋量が正常もしくは多い群と比較して、骨格筋量が少ない群では有意に生存率が悪かったです。周術期の栄養療法は、骨格筋量が少ない患者の生存率を有意に改善しました。多変量解析では、骨格筋減少は独立した移植後の死亡のリスク因子でした。

生体肝移植患者ですので、加齢によるサルコペニアというよりは疾患と栄養によるサルコペニアや悪液質の影響が大きいと思われます。そのため、周術期の栄養療法で生存率が改善したのではと推測します。腹部CTでのサルコペニア評価でもよいかなと考えます。

Abstract

Skeletal muscle depletion, referred to as sarcopenia, predicts morbidity and mortality in patients undergoing digestive surgery. However, the impact on liver transplantation is unclear. The present study investigated the impact of sarcopenia on patients undergoing living donor liver transplantation (LDLT). Sarcopenia was assessed by a body composition analyzer in 124 adult patients undergoing LDLT between February 2008 and April 2012. The correlation of sarcopenia with other patient factors and the impact of sarcopenia on survival after LDLT were analyzed. The median ratio of preoperative skeletal muscle mass was 92% (range, 67-130%) of the standard mass. Preoperative skeletal muscle mass was significantly correlated with the branched-chain amino acids to tyrosine ratio (r = -0.254, p = 0.005) and body cell mass (r = 0.636, p < 0.001). The overall survival rate in patients with low skeletal muscle mass was significantly lower than in patients with normal/high skeletal muscle mass (p < 0.001). Perioperative nutritional therapy significantly increased overall survival in patients with low skeletal muscle mass (p = 0.009). Multivariate analysis showed that low skeletal muscle mass was an independent risk factor for death after transplantation. In conclusion, sarcopenia was closely involved with posttransplant mortality in patients undergoing LDLT. Perioperative nutritional therapy significantly improved overall survival in patients with sarcopenia.