Original article
General thoracic
Sarcopenia of the Psoas Muscles Is Associated With Poor Outcomes Following Lung Transplantation

Presented at the Thirty-eighth Annual Meeting of the International Society for Heart and Lung Transplantation, Nice, France, April 10–14, 2018.
https://doi.org/10.1016/j.athoracsur.2018.10.006Get rights and content

Background

Sarcopenia, a known component of frailty, defined by diminished cross-sectional area of the psoas muscles, is associated with poor outcomes after a range of surgical procedures. However, little is known of the relationship between sarcopenia of the psoas muscles (SPM) and long-term survival, decline in pulmonary function, and graft failure after lung transplantation.

Methods

We reviewed patients who underwent primary lung transplantation at our institution from 2011 to 2014. Cross-sectional areas of the psoas muscles at the L4 vertebral level were measured using preoperative computed tomography. Gender-based cutoff values for sarcopenia were generated and validated. The primary outcomes were 1-, 2-, and 3-year all-cause mortality, forced expiratory volume in 1 second values, and graft function. Adjusted logistic regression and survival analysis was used to analyze outcomes.

Results

Ninety-five patients were included in this study; 39 (41.1%) patients were considered sarcopenic. SPM was significantly associated with short-term and midterm mortality on multivariate analysis (1 year: odds ratio [OR], 8.7, p = 0.017; 2 years: OR, 12.7, p < 0.01; 3 years: OR, 13.4, p < 0.01). Survival analysis showed significantly decreased survival in sarcopenic patients at 3 years (35.9% versus 76.8%; p < 0.01). SPM is also associated with decreased forced expiratory volume in 1 second (coefficient, –17.3; p = 0.03). Adjusted Cox analysis showed an increased hazard for all-cause mortality (hazard ratio, 5.8, p < 0.01) and graft failure (hazard ratio, 14.7, p < 0.01) in sarcopenic patients.

Conclusions

This study demonstrates a significant association between SPM and death, pulmonary function, and graft failure in patients receiving a lung transplant. Determining SPM preoperatively may be a useful component of frailty assessment and a predictor of survival in this patient population.

Section snippets

Patient Population

We conducted a retrospective study of all patients who underwent either unilateral or bilateral orthotopic lung transplant at Johns Hopkins Hospital from January 2011 to December 2014. Patients were included in the study if they had an abdominal CT imaging within 6 months before operation as sarcopenia represents chronic muscle wasting. They were excluded from the study if they lacked relevant CT imaging, or had a CT that did not allow for analysis of the psoas muscles at the L4 level. Patient

Study Population

A total of 97 patients underwent orthotopic lung transplantation at Johns Hopkins over a 4-year period. Two patients were excluded from analysis due to lack of abdominal CT within 6 months before operation. Therefore, 95 patients met our inclusion criteria and had a median follow-up of 3.5 years. Patient demographic and comorbidity data are presented in Table 1. The mean age was 50.1 ± 15.2 years and 47 (49.5%) patients were women. Most patients were white (83.1%, n = 79) and the most common

Comment

Our study establishes statistically validated cutoffs for sarcopenia in lung transplant candidates based on indexed psoas muscle cross-sectional area determined by single-slice CT scan. We showed that SPM is significantly associated with death, diminished pulmonary function, any-grade BOS, and graft failure after lung transplantation. Additionally, our multivariate model of SPM exhibited a high degree of sensitivity and specificity for predicting mortality.

Previous studies have shown the

References (30)

  • A.B. Smith et al.

    Sarcopenia as a predictor of complications and survival following radical cystectomy

    J Urol

    (2014)
  • H. Shirai et al.

    Preoperative low muscle mass has a strong negative effects on pulmonary function in patients undergoing living donor liver transplantation

    Nutrition

    (2018)
  • L. Fried et al.

    Frailty in older adults evidence for a phenotype

    J Gerontol A Biol Sci Med Sci

    (2001)
  • M.D. Goldman et al.

    Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls

    Mult Scler

    (2008)
  • V.L. Keevil et al.

    Ageing well: a review of sarcopenia and frailty

    Proc Nutr Soc

    (2015)
  • Cited by (48)

    • Erector spinae muscle radiographic density is associated with survival after lung transplantation

      2022, Journal of Thoracic and Cardiovascular Surgery
      Citation Excerpt :

      Although various studies have described the significant impact of low BMI and small ESM mass (ESMCSA) on prognosis in patients with COPD25,26,37 and lung cancer,38,39 these factors were not associated with poor survival after LTx (Figure E5, Table 3). Although this finding is consistent with other studies in the literature, the relationship between preoperative small skeletal muscle mass and prognosis after LTx in previous studies has been controversial.11,21,22,40,41 Moreover, in our previous study, a low ESMCT preoperatively was associated with the recovery of ESMCSA.23

    • Rib Fracture Mortality: Are there clues in the core?

      2021, Journal of Surgical Research
      Citation Excerpt :

      There has been a growing body of literature that uses the measurement of sarcopenia to estimate frailty. Decreased psoas muscle size on computed tomography (CT), in multiple disciplines, has also been used as a frailty marker and has been shown to be an independent prognostic indicator.10-17 Specifically, in the trauma patient population sarcopenia defined by cross-sectional imaging has a debated utility.

    View all citing articles on Scopus

    Mr Hsu and Mr Krishnan contributed equally to this work.

    View full text