Low muscle mass in intestinal transplant recipients: Prevalence, outcomes, and longitudinal analysis of body composition

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-05-24 DOI:10.1016/j.clnesp.2025.05.035

Julie Varkey , Kirsten Mehlig , Antal Bajor , Shilla Khalil , Mihai Oltean , Markus Gäbel , William Bennet , Jonas Varkey

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引用次数: 0

Abstract

Background

Intestinal transplantation (ITX) is a life-saving treatment for patients with irreversible intestinal failure. While short-term survival has improved, long-term outcomes remain challenging, and the role of Low Muscle Mass (LMM) in influencing post-transplant outcomes is unclear. This study investigates the prevalence and impact of LMM on long-term survival in adults who underwent ITX, while also examining the longitudinal changes in body composition following transplantation.

Methods

This retrospective study included 26 adult patients who underwent ITX from February 2000 to August 2023. Body composition was assessed using Dual-Energy X-ray Absorptiometry (DEXA) scans, focusing on appendicular skeletal muscle mass index (ASMI) as an indicator of LMM. Longitudinal changes in ASMI, body fat percentage, body mass index (BMI), and bone mineral density (BMD) were analyzed using mixed linear regression models. Survival analysis was conducted using Kaplan–Meier curves and Cox proportional hazards regression.

Results

Pre-transplant LMM was prevalent in 58 % of patients. Patients with LMM were younger (34 years vs. 49 years, p = 0.001), with lower BMI (18.8 vs. 23.4, p = 0.003) and ASMI (5.1 vs. 6.8, p = 0.0003). Over up to 10 years of follow-up, average ASMI change was 0.02 kg/m²/year (−0.06, 0.10), showing positive time trends in patients younger than 40 years and negative trends in older patients (interaction p = 0.04). A similar age dependence was seen for BMD (interaction p = 0.01). ASMI, BMI, and fat percentage increased from pre-TX to the most recent follow-up, but these changes were not significantly different from zero. Additionally, 5-year mortality and overall survival rates did not significantly differ by pre-TX LMM status.

Conclusion

Pre-TX LMM is common in ITX patients but does not significantly impact long-term survival or body composition post-transplant. Thus, LMM alone may not be a contraindication for ITX, and muscle mass remained relatively stable over the follow-up period.

查看原文本刊更多论文

肠移植受者的低肌肉量：患病率、结果和身体组成的纵向分析。

背景：肠移植（ITX）是一种挽救不可逆肠衰竭患者生命的治疗方法。虽然短期生存率有所提高，但长期预后仍然具有挑战性，低肌肉质量（LMM）在影响移植后预后中的作用尚不清楚。本研究调查了接受ITX的成人中LMM的患病率和对长期生存的影响，同时也研究了移植后身体成分的纵向变化。方法：回顾性研究纳入了2000年2月至2023年8月26例接受ITX手术的成人患者。采用双能x线吸收仪（DEXA）扫描评估身体成分，重点关注阑尾骨骼肌质量指数（ASMI）作为LMM的指标。采用混合线性回归模型分析ASMI、体脂率、体质指数（BMI）和骨密度（BMD）的纵向变化。生存率分析采用Kaplan-Meier曲线和Cox比例风险回归。结果：移植前LMM发生率为58%。LMM患者较年轻（34岁对49岁，p=0.001）， BMI（18.8对23.4,p=0.003）和ASMI（5.1对6.8,p=0.0003）较低。在长达10年的随访中，ASMI的平均变化为0.02 kg/m2/年（-0.06,0.10），年龄小于40岁的患者呈阳性时间趋势，年龄较大的患者呈阴性趋势（相互作用p=0.04）。骨密度也有类似的年龄依赖性（相互作用p=0.01）。ASMI， BMI和脂肪百分比从tx前到最近的随访有所增加，但这些变化与零没有显著差异。此外，5年死亡率和总生存率在tx前LMM状态下没有显著差异。结论：移植前LMM在ITX患者中很常见，但对移植后的长期生存或身体成分没有显著影响。因此，LMM单独可能不是ITX的禁忌症，并且在随访期间肌肉质量保持相对稳定。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.