Figures
- FIGURE 1
Study flowchart and scheme of our investigations and measures. BOS: bronchiolitis obliterans syndrome; LDLLT: living-donor lobar lung transplantation; CT: computed tomography; 6MWD: 6-min walk distance; PR: pulmonary rehabilitation.
- FIGURE 2
Representative computed tomography (CT) images used to measure the cross-sectional area (CSA) and attenuation of erector spinae muscles (ESMs) in recipients. Bilateral ESMs are shaded in green (a), and the frequency distribution of muscle attenuation is displayed (b). ESMCSA (in cm2) was calculated by summing the CSA of bilateral ESMs. ESMCT (in Hounsfield Units (HU)) was defined by the mean ESM attenuation. Images were acquired by SYNAPSE VINCENT (FUJIFILM Medical Co., Ltd, Tokyo, Japan).
- FIGURE 3
Time course of the postoperative changes in ESMs. Averages of the ESMCSA (a) and ESMCT (b) in the recipients (white) and donors (black) at each of the following time points: baseline, 3 months after LDLLT and 12 months after LDLLT. Ratios of the ESMCSA (c) and ESMCT (d) to baseline among the recipients (white) and donors (green) at each time point. **: p<0.01 compared to baseline; ¶: p<0.05, ¶¶: p<0.01 compared to 3 months; #: p<0.05, ##: p<0.01 by t-test.
Tables
- TABLE 1
Characteristics of the recipients and living donors at baseline
Variable Recipients Living donors p-value# Number of patients n 35 35 Indications for lung transplantation Interstitial lung disease 21 (60%) – Lung injury after haematopoietic stem cell transplantation 9 (26%) – Idiopathic pulmonary artery hypertension 2 (6%) – Bronchiectasis 2 (6%) – Idiopathic pulmonary hemosiderosis 1 (3%) – Smoking history (+) 15 (43%) 13 (37%) 0.63 mMRC score 0/1/2/3/4 n 0/0/0/16/19 33/2/0/0/0 <0.001 Female 19 (54%) 19 (54%) 1 Age years 46.8±13.2 (18–63) 45.1±10.9 (21–60) 0.50 Height m 1.60±0.09 (1.28–1.72) 1.63±0.06 (1.52–1.77) 0.11 Weight kg 48.0±10.8 (30.4–72.9) 60.9±9.4 (45.5–78.8) <0.001 BMI kg·m−2 18.5±3.3 (12.2–25.2) 22.6±2.8 (17.8–29.6) <0.001 Albumin g·dL−1 3.6±0.6 (2.0–5.0) 4.3±0.3 (3.7–5.2) <0.001 VC % predicted 44.6±17.2 (16.9–88.0)¶ 108.9±17.8 (85.1–169.8) <0.001 FEV1/FVC % 77.2±23.8 (21.1–100.0)¶ 82.5±5.5 (70.8–92.8) 0.21 FEV1 % predicted 38.9±19.0 (15.0–86.6)¶ 104.4±13.6 (81.6–131.8) <0.001 DLCO % predicted 24.1±14.5 (7.3–63.2)+ 92.7±10.3 (75.3–114.8) <0.001 6MWD m 209.0±104.3 (19.0–380.0)¶ 585.2±86.4 (400.0–736.0)ƒ <0.001 ESMCSA cm2 23.0±7.2 (11.3–39.9) 30.5±6.9 (19.7–45.8) <0.001 ESMCT HU 45.4±9.8 (13.8–59.8) 46.6±7.2 (30.9–57.6) 0.56 Quadriceps force Nm·kg-1 2.11±0.71 (0.82–3.48)§ – Procedure of LDLLT Single/double LTx n 2/33 – Right/left lower lobectomy n – 18/17 Predicted postoperative VC % predicted 61.6±15.1 (40.3–104.8) – Data are presented as n (%) or mean±sd (range), unless otherwise stated. mMRC: modified Medical Research Council; BMI: body mass index; VC: vital capacity; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; DLCO: diffusing capacity of the lung for carbon monoxide; 6MWD: 6-min walk distance; ESMCSA: cross-sectional area of the erector spinae muscles; ESMCT: mean computed tomography values of the erector spinae muscles. #: Chi-squared test or t-test; ¶: number of valid observations, 27; +: number of valid observations, 14; §: number of valid observations, 26; ƒ: number of valid observations, 33.
- TABLE 2
Outcome parameters for the recipients at each measurement time point
Variable Baseline 3 months after LDLLT 12 months after LDLLT BMI kg·m−2 18.5±3.3 (12.2–25.2) 17.8±3.2 (12.0–23.3)* 19.3±3.6 (12.0–25.5)## VC % predicted 44.6±17.2 (16.9–88.0) 54.0±16.8 (26.3–84.7)* 57.8±19.7 (15.6–101.0)** DLCO % predicted 24.1±14.5 (7.3–63.2) 48.4±12.9 (17.5–69.3)** 48.1±14.2 (23.7–84.6)** Steroid use 22 (63%) 34 (97%) 34 (97%) Average steroid dose mg·kg−1·day−1 0.18±0.19 (0–0.78) 0.38±0.08 (0–0.45) 0.20±0.12 (0–0.65) Cumulative steroid dose mg·kg−1 – 61.6±9.1 (39.0–82.7) 149.6±26.5 (52.0–215.8) CLAD – – 2 (6%) Data are presented as mean±sd deviation (range) or n (%). LDLLT: living-donor lobar lung transplantation; BMI: body mass index; VC: vital capacity; DLCO: diffusing capacity of the lung for carbon monoxide; CLAD: chronic lung allograft dysfunction. *: p<0.05 compared to baseline; **: p<0.01 compared to baseline; ##: p<0.01 compared to 3 months after LDLLT.
- TABLE 3
Differences in baseline characteristics and clinical courses between the groups with and without changes from baseline to 12 months after LDLLT in the ESMCSA or ESMCT
ESMCSA at 12 months after LDLLT ESMCT at 12 months after LDLLT Ratio to baseline <1 Ratio to baseline ≥1 p-value# Ratio to baseline <1 Ratio to baseline ≥1 p-value# Patients n 15 20 28 7 Female n (%) 9 (60%) 10 (50%) 0.57 15 (46%) 4 (43%) 0.87 mMRC score 0/1/2/3/4 n 0/0/0/8/7 0/0/0/8/12 0.43 0/0/0/13/15 0/0/0/3/4 0.60 Age years 49.9±11.1 44.5±14.4 0.23 46.3±13.4 48.6±12.9 0.69 BMI kg·m−2 20.2±3.4 17.2±2.5 0.004 18.5±3.3 18.5±3.1 0.98 Albumin g·dL−1 3.7±0.6 3.6±0.5 0.70 3.6±0.6 3.7±0.6 0.94 VC % predicted 47.3±16.8 42.1±17.7 0.44 45.4±18.2 41.8±13.8 0.66 FEV1/FVC % 84.7±20.1 70.1±25.5 0.11 75.8±23.4 81.9±26.9 0.59 FEV1 % predicted 47.6±18.3 30.8±16.4 0.02 38.7±19.2 39.7±19.9 0.91 DLCO % predicted 21.5±16.5 28.7±9.9 0.40 25.2±15.3 17.5±7.4 0.51 6MWD m 225.7±107.9 195.6±103.0 0.47 204.5±107.7 228.6±95.5 0.65 ESMCSA cm2 26.3±8.2 20.6±5.3 0.02 23.0±7.1 23.2±8.2 0.95 ESMCT HU 40.9±11.4 48.8±6.8 0.02 46.7±8.2 40.3±14.0 0.12 Predicted postoperative VC % predicted 59.0±10.8 63.6±17.6 0.37 61.5±16.4 62.3±8.5 0.65 Preoperative steroid use n (%) 8 (53%) 14 (70%) 0.33 19 (68%) 3 (43%) 0.23 Postoperative steroid pulse therapy n (%) 11 (73%) 14 (70%) 0.84 21 (75%) 4 (57%) 0.36 Postoperative cumulative steroid dose mg·kg−1 148.4±30.7 150.5±23.6 0.81 147.7±26.3 157.1±28.0 0.41 Tacrolimus use n (%) 12 (80%) 8 (40%) 0.02 17 (61%) 3 (43%) 0.41 Tracheostomy n (%) 11 (73%) 9 (45%) 0.10 18 (64%) 2 (29%) 0.09 Duration of mechanical ventilation days 17.7±18.0 10.1±11.0 0.13 15.4±15.6 5.4±5.7 0.11 Initial walking, postoperative days 15.0±11.0 10.2±6.0 0.11 12.7±9.4 10.9±6.3 0.63 Intensive care unit stay days 13.5±7.8 10.4±3.5 0.12 12.5±6.0 8.4±4.1 0.10 Hospital stay days 96.9±67.3 78.0±21.0 0.24 85.2±51.6 89.6±22.1 0.83 Δ at 3 months of ESMCSA, cm2 (3 months – baseline) −4.5±4.6 −0.6±1.8 0.001 −2.2±3.8 −2.5±4.0 0.86 Δ at 3 months of ESMCT, HU (3 months – baseline) −3.3±6.5 −3.9±5.8 0.79 −5.3±5.4 3.1±3.1 <0.001 Data are presented as mean±sd or n (%), unless otherwise stated. Δ at 3 months of ESMCSA and ESMCT were calculated by subtracting the values at baseline from those at 3 months (3 months – baseline). LDLLT: living-donor lobar lung transplantation; ESMCSA: cross-sectional area of the erector spinae muscles; ESMCT: mean computed tomography values of the erector spinae muscles; mMRC: modified Medical Research Council; BMI: body mass index; VC: vital capacity; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; DLCO: diffusing capacity of the lung for carbon monoxide; 6MWD: 6-min walk distance.#: Chi-squared test or t-test.
- TABLE 4
Multivariate logistic regression analysis for increased ESMCSA or ESMCT from baseline to 12 months after LDLLT
Variable Increased ESMCSA at 12 months (ratio to baseline >1) Increased ESMCT at 12 months (ratio to baseline >1) Odds ratio 95% CI p-value Odds ratio 95% CI p-value BMI kg·m−2 0.88 0.61–1.25 0.48 – – – ESMCT HU 1.20 1.06–1.248 0.001 1.00 0.83–1.01 0.92 Tacrolimus use n 0.23 0.03–1.53 0.13 – – – Tracheostomy n – – – 0.40 0.032–4.05 0.44 Δ at 3 months of ESMCSA, cm2 (3 months – baseline) 2.54 1.31–7.22 0.002 – – – Δ at 3 months of ΔESMCT, HU (3 months – baseline) – – – 1.60 1.17–2.62 0.001 R2 0.54 0.46 Increased ESMCSA and increased ESMCT at 3 months were calculated by subtracting the values at baseline from those at 3 months. ESMCSA: cross-sectional area of the erector spinae muscles; ESMCT: mean computed tomography values of the erector spinae muscles; LDLLT: living-donor lobar lung transplantation; BMI: body mass index; CI: confidence interval; R2: coefficient of determination.
- TABLE 5
Univariate and multivariate analyses of factors associated with the 6MWD at 3 and 12 months after LDLLT
Variable 3 months 12 months Univariate Multivariate Univariate Multivariate r p β p r p β p Age years 0.10 0.58 −0.19 0.20 −0.12 0.50 −0.28 0.030 Sex female=1 −0.52 0.002 −0.49 0.003 −0.36 0.04 −0.41 0.016 VC % predicted 0.59 0.004 0.55 0.006 0.61 <0.001 0.54 0.005 ESMCSA cm2 0.59 <0.001 −0.12 0.56 0.59 <0.001 −0.17 0.47 ESMCT HU 0.54 0.001 0.29 0.037 0.65 <0.001 0.47 <0.001 R2 − 0.60 − 0.65 6MWD: 6-min walk distance; LDLLT: living-donor lobar lung transplantation; VC: vital capacity; ESMCSA: cross-sectional area of the erector spinae muscles; ESMCT: mean computed tomography values of the erector spinae muscles; HU: Hounsfield Units; r: Pearson's correlation coefficient; β: standardised coefficient; R2: coefficient of determination.
Supplementary Material
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Supplementary material 00205-2019.SUPPLEMENT
