Korean J Radiol.  2019 Mar;20(3):522-530. 10.3348/kjr.2018.0241.

Association of Chest CT-Based Quantitative Measures of Muscle and Fat with Post-Lung Transplant Survival and Morbidity: A Single Institutional Retrospective Cohort Study in Korean Population

• Cho YH
• Do KH
• Chae EJ
• Choi SH
• Jo KW
• Lee SO
• Hong SB

• KMID: 2438283
• DOI: http://doi.org/10.3348/kjr.2018.0241

Abstract

OBJECTIVE
Abnormal body composition is an important modifiable risk factor in lung transplantation. Therefore, precise quantification of different body components, including muscle and fat, may play an important role in optimizing outcomes in lung transplant patients. The purpose of the study was to investigate the prognostic significance of muscle and subcutaneous fat mass measured on chest CT with regard to lung transplantation survival and other post-transplant outcomes.
MATERIALS AND METHODS
The study population included 45 consecutive adult lung transplant recipients (mean age of 47.9 ± 12.1 years; 31 males and 14 females) between 2011 and 2017. Preoperative cross-sectional areas of muscle and subcutaneous fat were semi-automatically measured on axial CT images at the level of the 12th thoracic vertebra (T12). Additional normalized indexed parameters, adjusted for either height or weight, were obtained. Associations of quantitative parameters with survival and various other post-transplant outcomes were evaluated.
RESULTS
Of the 45 patients included in the present study, 10 mortalities were observed during the follow-up period. Patients with relative sarcopenia (RS) classified based on height-adjusted muscle area with a cut-off value of 28.07 cm²/m² demonstrated worse postoperative survival (log-rank test, p = 0.007; hazard ratio [HR], 6.39:1) despite being adjusted for age, sex, and body mass index (HR, 8.58:1; p = 0.022). Weight-adjusted parameters of muscle area were negatively correlated with duration of ventilator support (R = −0.54, p < 0.001) and intensive care unit (ICU) stay (R = −0.33, p = 0.021).
CONCLUSION
Patients with RS demonstrate worse survival after lung transplantation that those without RS. Additionally, quantitative parameters of muscles measured at the T12 level on chest CT were associated with the duration of post-lung transplant ventilator support and duration of stay in the ICU.

Keyword

Lung transplantation; Sarcopenia; Fat; Muscle; Chest CT; Survival

MeSH Terms

Adult
Body Composition
Body Mass Index
Cohort Studies*
Follow-Up Studies
Humans
Intensive Care Units
Lung
Lung Transplantation
Male
Mortality
Muscles
Retrospective Studies*
Risk Factors
Sarcopenia
Spine
Subcutaneous Fat
Thorax*
Tomography, X-Ray Computed
Transplant Recipients
Ventilators, Mechanical

Figure

• 

  Fig. 1 Flow diagram of study population.Final study population included 45 adult lung transplantation recipients from 2011 to 2017. CT = computed tomography

• 

  Fig. 2 Example of cross-sectional area measurement at level of 12th thoracic vertebra.Cross-sectional total muscle area (pink) and subcutaneous fat area (red) were automatically calculated using predefined CT HU thresholds (muscle, −29 to 150 HU; subcutaneous fat, −190 to −30 HU). HU = Hounsfield unit

• 

  Fig. 3 Post-transplantation survival analysis.Patients with relative sarcopenia were associated with worse overall survival (green line) (log-rank test, p = 0.007). Relative hazard ratio estimated using Cox-regression analysis was 6.39:1 (p = 0.019) for univariate and 8.58:1 (p = 0.022) for multivariate analysis, adjusted for recipient's age, sex, and body mass index.

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