Effect of Sarcopenic Overweight on Lung Transplant Based in Three-Dimensional Reconstructed Psoas Muscle Mass

In lung transplantation, preoperative sarcopenia was reported to be associated with short-term outcomes based on cross-sectional image. This study aimed to investigate the influence of psoas muscle mass (PMM) on the operative outcome and survival using three-dimensional reconstruction of PMM and to evaluate the effect of preoperative sarcopenic overweight on postoperative outcomes and survival.

A total of 107 patients who underwent double lung transplantation in one institute from January 1, 2014, to June 30, 2017, were enrolled. The PMM was measured by Synapse 3D (Fujifilm, Seoul, Korea) visualization software based on computed tomography and three-dimensional reconstruction images. Patients were separated into two groups according to tercile of PMM (below the first tercile was defined as sarcopenia) and then subdivided according to PMM and overweight (body mass index ≥23 kg/m²).

Sarcopenia had a significant relation with higher rate of postoperative tracheostomy (p = 0.040) and operative mortality (p = 0.023). For survival analysis, patients with sarcopenia showed a trend toward poorer outcome, but it was not significant (3-year survival rate 50.2% versus 73.2%, p = 0.054). Moreover, PMM was significantly associated with the length of mechanical ventilation (ß = -0.368, p = 0.047) and length of intensive care unit stay (ß = -0.372, p = 0.046). Sarcopenic overweight has no significant difference in terms of length of mechanical ventilation and length of intensive care unit. However, overall survival was significantly lower among patients with sarcopenic overweight than among those without sarcopenia (p = 0.026 and p = 0.024, respectively).

Sarcopenia was associated with poorer short-term outcome, and sarcopenic overweight with poorer overall survival of lung transplant patients.