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CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg
DOI: 10.1055/s-0044-1782683
Original Thoracic

Computed Tomography-Based Body Composition is Related to Perioperative Morbidity in Older Lung Transplant Recipients

Daria Kifjak
1   Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Wien, Austria
2   Department of Radiology, UMass Memorial Medical Center and University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States
,
Helmut Prosch
1   Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Wien, Austria
,
Stefan Schwarz
3   Department of Thoracic Surgery, Medical University of Vienna, Wien, Wien, Austria
,
Peter Jaksch
3   Department of Thoracic Surgery, Medical University of Vienna, Wien, Wien, Austria
,
Michael Weber
1   Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Wien, Austria
,
Konrad Hoetzenecker
3   Department of Thoracic Surgery, Medical University of Vienna, Wien, Wien, Austria
,
Thomas Schweiger
3   Department of Thoracic Surgery, Medical University of Vienna, Wien, Wien, Austria
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Abstract

Background In older patients, a limited physical reserve is considered a contraindication for lung transplantation (LTx). Herein, we aimed to establish a computed tomography (CT)-based quantification of physical reserve in older patients scheduled for transplantation.

Methods This retrospective study included patients older than 60 years who received LTx. Semiautomatic measurements of the mediastinal fat area and the dorsal muscle group area in pretransplantation CT scans were performed, and normalized data were correlated with clinical parameters.

Results Patients (n = 108) were assigned into three groups (Musclehighfatlow [n = 25], Musclelowfathigh [n = 24], and other combinations [n = 59]). The Musclelowfathigh group had a significantly increased risk of wound infections (p = 0.002) and tracheostomy (p = 0.001) compared with Musclehighfatlow patients. The median length of intensive care unit stay (25 vs. 3.5 days; p = 0.002) and the median length of hospital stay (44 vs. 22.5 days; p = 0.013) post-LTx were significantly prolonged in the Musclelowfathigh group. Significantly more patients in this group had a prolonged ventilation time (11 vs. 0; p < 0.001).

Conclusion Body composition parameters determined in pretransplant chest CT scans in older LTx candidates might aid in identifying high-risk patients with a worse perioperative outcome after LTx.

Keywords

lung transplantation - body composition - biological age - frailty - older patients

Abbreviations

6MWT, six-minute-walk test


AMF, anterior mediastinal fat


BMI, body mass index


CA, chronological age


COPD, chronic obstructive pulmonary disease


CT, computed tomography


DMG, dorsal muscle group


ECMO, extracorporeal membrane oxygenation


FEV1, forced expiratory volume


HU, Hounsfield units


ICU, intensive care unit


LAS, lung allocation score


LTx, lung transplantation


MFA, mediastinal fat area


PGD, primary graft dysfunction


SMI, skeletal muscle indices


TMA, total muscle area


Supplementary Material



Publication History

Received: 04 September 2023

Accepted: 23 February 2024

Article published online:
16 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
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