Introduction

Survival following lung transplant is low. With limited donor lung availability, predicting post-transplant survival is key. We investigated the predictive value of pre-transplant CT biomarkers on survival.

Methods

In this single-center retrospective cohort study of adults in a diverse, underserved, urban lung transplant program (11/8/2017–5/20/2022), chest CTs were analyzed using TeraRecon to assess musculature, fat, and bone. Erector spinae and pectoralis muscle area and attenuation were analyzed. Sarcopenia thresholds were 34.3 (women) and 38.5 (men) Hounsfield Units (HU). Visceral and subcutaneous fat area and HU, and vertebral body HU were measured. Demographics and pre-transplant metrics were recorded. Survival analyses included Kaplan–Meier and Cox proportional hazard.

Results

The study cohort comprised 131 patients, 50 women, mean age 60.82 (SD 10.15) years, and mean follow-up 1.78 (SD 1.23) years. Twenty-nine percent were White. Mortality was 32.1%. Kaplan–Meier curves did not follow the proportional hazard assumption for sex, so analysis was stratified. Pre-transplant EMR metrics did not predict survival. Women without sarcopenia at erector spinae or pectoralis had 100% survival (p = 0.007). Sarcopenia did not predict survival in men and muscle area did not predict survival in either sex. Men with higher visceral fat area and HU had decreased survival (p = 0.02). Higher vertebral body density predicted improved survival in men (p = 0.026) and women (p = 0.045).

Conclusion

Pre-transplantation CT biomarkers had predictive value in lung transplant survival and varied by sex. The absence of sarcopenia in women, lower visceral fat attenuation and area in men, and higher vertebral body density in both sexes predicted survival in our diverse, urban population.

中文翻译：

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CT 生物标志物对肺移植存活率的预测价值：对多样化、服务不足的城市人群的初步调查

介绍

肺移植后的存活率很低。由于供体肺的可用性有限，预测移植后的存活率是关键。我们研究了移植前 CT 生物标志物对生存的预测价值。

方法

在这项对参与多样化、服务不足的城市肺移植项目（11/8/2017-5/20/2022）的成年人进行的单中心回顾性队列研究中，使用 TeraRecon 分析胸部 CT 来评估肌肉组织、脂肪和骨骼。分析竖脊肌和胸肌的面积和衰减。肌肉减少症阈值分别为 34.3（女性）和 38.5（男性）亨斯菲尔德单位 (HU)。测量内脏和皮下脂肪面积和HU，以及椎体HU。记录人口统计数据和移植前指标。生存分析包括 Kaplan-Meier 和 Cox 比例风险。

结果

该研究队列包括 131 名患者，其中 50 名女性，平均年龄 60.82 (SD 10.15) 岁，平均随访时间 1.78 (SD 1.23) 年。百分之二十九是白人。死亡率为32.1%。Kaplan-Meier 曲线不遵循性别比例风险假设，因此分析是分层的。移植前 EMR 指标并不能预测生存率。没有竖脊肌或胸肌少肌症的女性存活率为 100% ( p  = 0.007)。肌肉减少症不能预测男性的生存，肌肉区域不能预测任何性别的生存。内脏脂肪面积和 HU 较高的男性生存率较低 ( p  = 0.02)。椎体密度越高，男性 ( p  = 0.026) 和女性 ( p  = 0.045) 的生存率越高。

结论

移植前 CT 生物标志物对肺移植存活率具有预测价值，并且因性别而异。女性没有肌肉减少症，男性内脏脂肪衰减和面积较低，以及两性椎体密度较高，这些都预示着我们多样化的城市人口的生存。