补充左旋肉碱对肌肉减少症肝移植患者移植后预后的影响：一项随机对照开放标签试验。

IF 2.6 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-09-15 DOI:10.1016/j.clnesp.2025.09.008

Marwa Abd El-Razek Salama, Elham Ahmed Hassan, Nahed A. Makhlouf

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引用次数: 0

摘要

背景与目的：骨骼肌减少症以骨骼肌质量和力量的减少为特征，是晚期肝脏疾病的常见并发症，并恶化移植后的预后。虽然左旋肉碱可以改善肌肉质量和功能，但其对肌肉减少性肝移植候选人的影响尚不清楚。我们的目的是评估补充左旋肉碱对肝移植后肌肉减少患者的临床结果和死亡率的影响。方法：这项随机对照研究纳入了53例等待肝移植的丙型肝炎相关肝硬化患者，分为三组：肌肉减少症合并左旋肉碱（n= 18）、肌肉减少症不合并左旋肉碱（n= 18）和非肌肉减少症（n= 17）。在移植前和移植后6个月评估临床、人体测量、肌肉质量和生化参数（次要结局），以及移植后死亡率（主要结局）。结果：肌少症患者接受左肉碱治疗后，在腹水、下肢水肿、人体测量（TSF、MAC、握力）和生化指标（INR、白蛋白、胆红素、血小板）方面均有显著改善。与没有左肉碱的患者相比，补充组在肌肉质量指数（1 vs. 0 cm2/m2; P = 0.014）、TSF （4 vs. -4 mm; P = 0.049）、BMI （2 vs. -2 kg/m2; P = 0.026）和胆红素降低（-15.2 vs. 20.5 mmol/L; P = 0.001）方面取得了更大的增长。左旋肉碱组的死亡率显著降低（16.7% vs. 55.6%; P = 0.003），生存率与非肌少症患者相当。结论：肌少症肝移植患者补充左旋肉碱可显著改善移植后预后、肌肉质量和生存率，死亡率与非肌少症患者相当。这些发现表明，在这一高危人群中，左旋肉碱在优化移植前护理和提高移植后预后方面具有潜在作用。

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Impact of L-carnitine supplementation on post-transplant outcomes in liver transplant candidates with sarcopenia: A randomized controlled open-label trial

Background & aims

Sarcopenia, characterized by loss of skeletal muscle mass and strength, is a common complication of advanced liver disease and worsens post-transplant outcomes. While L-carnitine may improve muscle mass and function, its impact on sarcopenic liver transplant candidates remains unclear. We aimed to evaluate the impact of L-carnitine supplementation on clinical outcomes and mortality in sarcopenic patients following liver transplantation.

Methods

This randomized, controlled study included 53 HCV-related cirrhotic patients awaiting liver transplantation, divided into three groups: sarcopenia with L-carnitine (n = 18), sarcopenia without L-carnitine (n = 18), and non-sarcopenia (n = 17). Clinical, anthropometric, muscle mass, and biochemical parameters (secondary outcomes) were evaluated before and 6 months after transplantation, along with post-transplant mortality (primary outcome).

Results

Sarcopenic patients receiving L-carnitine showed significant post-transplant improvements in ascites, lower limb edema, anthropometric measures (TSF, MAC, handgrip), and biochemical markers (INR, albumin, bilirubin, platelets). Compared to patients without L-carnitine, the supplemented group achieved greater gains in muscle mass index (1 vs. 0 cm²/m²; P = 0.014), TSF (4 vs. −4 mm; P = 0.049), BMI (2 vs. −2 kg/m²; P = 0.026), and reductions in bilirubin (−15.2 vs. 20.5 mmol/L; P = 0.001). Mortality was significantly lower in the L-carnitine group (16.7 % vs. 55.6 %; P = 0.003), with survival rates comparable to non-sarcopenic patients.

Conclusion

L-carnitine supplementation in sarcopenic liver transplant candidates significantly improved post-transplant outcomes, muscle mass, and survival with mortality rates comparable to non-sarcopenic patients. These findings suggest a potential role of L-carnitine in optimizing pre-transplant care and enhancing post-transplant outcomes in this high-risk population.

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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.