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Quantity and quality of antigravity muscles in patients undergoing living-donor lobar lung transplantation: 1-year longitudinal analysis using chest computed tomography images

Yohei Oshima, Susumu Sato, Toyofumi F. Chen-Yoshikawa, Yuji Yoshioka, Nana Shimamura, Ryota Hamada, Manabu Nankaku, Akira Tamaki, Hiroshi Date, Shuichi Matsuda
ERJ Open Research 2020 6: 00205-2019; DOI: 10.1183/23120541.00205-2019
Yohei Oshima
1Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
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Susumu Sato
1Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
2Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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  • ORCID record for Susumu Sato
  • For correspondence: ssato@kuhp.kyoto-u.ac.jp
Toyofumi F. Chen-Yoshikawa
3Dept of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Yuji Yoshioka
1Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
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Nana Shimamura
1Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
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Ryota Hamada
1Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
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Manabu Nankaku
1Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
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Akira Tamaki
4Dept of Rehabilitation Science, Graduate School of Health Science, Hyogo University of Health Sciences, Kobe, Japan
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Hiroshi Date
3Dept of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Shuichi Matsuda
1Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
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  • FIGURE 1
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    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
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    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
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    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

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  • TABLE 1

    Characteristics of the recipients and living donors at baseline

    VariableRecipientsLiving donorsp-value#
    Number of patients n3535
    Indications for lung transplantation
     Interstitial lung disease21 (60%)–
     Lung injury after haematopoietic stem cell transplantation9 (26%)–
     Idiopathic pulmonary artery hypertension2 (6%)–
     Bronchiectasis2 (6%)–
     Idiopathic pulmonary hemosiderosis1 (3%)–
    Smoking history (+)15 (43%)13 (37%)0.63
    mMRC score 0/1/2/3/4 n0/0/0/16/1933/2/0/0/0<0.001
    Female19 (54%)19 (54%)1
    Age years46.8±13.2 (18–63)45.1±10.9 (21–60)0.50
    Height m1.60±0.09 (1.28–1.72)1.63±0.06 (1.52–1.77)0.11
    Weight kg48.0±10.8 (30.4–72.9)60.9±9.4 (45.5–78.8)<0.001
    BMI kg·m−218.5±3.3 (12.2–25.2)22.6±2.8 (17.8–29.6)<0.001
    Albumin g·dL−13.6±0.6 (2.0–5.0)4.3±0.3 (3.7–5.2)<0.001
    VC % predicted44.6±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 % predicted38.9±19.0 (15.0–86.6)¶104.4±13.6 (81.6–131.8)<0.001
    DLCO % predicted24.1±14.5 (7.3–63.2)+92.7±10.3 (75.3–114.8)<0.001
    6MWD m209.0±104.3 (19.0–380.0)¶585.2±86.4 (400.0–736.0)ƒ<0.001
    ESMCSA cm223.0±7.2 (11.3–39.9)30.5±6.9 (19.7–45.8)<0.001
    ESMCT HU45.4±9.8 (13.8–59.8)46.6±7.2 (30.9–57.6)0.56
    Quadriceps force Nm·kg-12.11±0.71 (0.82–3.48)§–
    Procedure of LDLLT
     Single/double LTx n2/33–
     Right/left lower lobectomy n–18/17
    Predicted postoperative VC % predicted61.6±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

      VariableBaseline3 months after LDLLT12 months after LDLLT
      BMI kg·m−218.5±3.3 (12.2–25.2)17.8±3.2 (12.0–23.3)*19.3±3.6 (12.0–25.5)##
      VC % predicted44.6±17.2 (16.9–88.0)54.0±16.8 (26.3–84.7)*57.8±19.7 (15.6–101.0)**
      DLCO % predicted24.1±14.5 (7.3–63.2)48.4±12.9 (17.5–69.3)**48.1±14.2 (23.7–84.6)**
      Steroid use22 (63%)34 (97%)34 (97%)
      Average steroid dose mg·kg−1·day−10.18±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 LDLLTESMCT at 12 months after LDLLT
        Ratio to baseline <1Ratio to baseline ≥1p-value#Ratio to baseline <1Ratio to baseline ≥1p-value#
        Patients n1520287
        Female n (%)9 (60%)10 (50%)0.5715 (46%)4 (43%)0.87
        mMRC score 0/1/2/3/4 n0/0/0/8/70/0/0/8/120.430/0/0/13/150/0/0/3/40.60
        Age years49.9±11.144.5±14.40.2346.3±13.448.6±12.90.69
        BMI kg·m−220.2±3.417.2±2.50.00418.5±3.318.5±3.10.98
        Albumin g·dL−13.7±0.63.6±0.50.703.6±0.63.7±0.60.94
        VC % predicted47.3±16.842.1±17.70.4445.4±18.241.8±13.80.66
        FEV1/FVC %84.7±20.170.1±25.50.1175.8±23.481.9±26.90.59
        FEV1 % predicted47.6±18.330.8±16.40.0238.7±19.239.7±19.90.91
        DLCO % predicted21.5±16.528.7±9.90.4025.2±15.317.5±7.40.51
        6MWD m225.7±107.9195.6±103.00.47204.5±107.7228.6±95.50.65
        ESMCSA cm226.3±8.220.6±5.30.0223.0±7.123.2±8.20.95
        ESMCT HU40.9±11.448.8±6.80.0246.7±8.240.3±14.00.12
        Predicted postoperative VC % predicted59.0±10.863.6±17.60.3761.5±16.462.3±8.50.65
        Preoperative steroid use n (%)8 (53%)14 (70%)0.3319 (68%)3 (43%)0.23
        Postoperative steroid pulse therapy n (%)11 (73%)14 (70%)0.8421 (75%)4 (57%)0.36
        Postoperative cumulative steroid dose mg·kg−1148.4±30.7150.5±23.60.81147.7±26.3157.1±28.00.41
        Tacrolimus use n (%)12 (80%)8 (40%)0.0217 (61%)3 (43%)0.41
        Tracheostomy n (%)11 (73%)9 (45%)0.1018 (64%)2 (29%)0.09
        Duration of mechanical ventilation days17.7±18.010.1±11.00.1315.4±15.65.4±5.70.11
        Initial walking, postoperative days15.0±11.010.2±6.00.1112.7±9.410.9±6.30.63
        Intensive care unit stay days13.5±7.810.4±3.50.1212.5±6.08.4±4.10.10
        Hospital stay days96.9±67.378.0±21.00.2485.2±51.689.6±22.10.83
        Δ at 3 months of ESMCSA, cm2 (3 months – baseline)−4.5±4.6−0.6±1.80.001−2.2±3.8−2.5±4.00.86
        Δ at 3 months of ESMCT, HU (3 months – baseline)−3.3±6.5−3.9±5.80.79−5.3±5.43.1±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

          VariableIncreased ESMCSA at 12 months (ratio to baseline >1)Increased ESMCT at 12 months (ratio to baseline >1)
          Odds ratio95% CIp-valueOdds ratio95% CIp-value
          BMI kg·m−20.880.61–1.250.48–––
          ESMCT HU1.201.06–1.2480.0011.000.83–1.010.92
          Tacrolimus use n0.230.03–1.530.13–––
          Tracheostomy n–––0.400.032–4.050.44
          Δ at 3 months of ESMCSA, cm2 (3 months – baseline)2.541.31–7.220.002–––
          Δ at 3 months of ΔESMCT, HU (3 months – baseline)–––1.601.17–2.620.001
          R20.540.46

          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

            Variable3 months12 months
            UnivariateMultivariateUnivariateMultivariate
            rpβprpβp
            Age years0.100.58−0.190.20−0.120.50−0.280.030
            Sex female=1−0.520.002−0.490.003−0.360.04−0.410.016
            VC % predicted0.590.0040.550.0060.61<0.0010.540.005
            ESMCSA cm20.59<0.001−0.120.560.59<0.001−0.170.47
            ESMCT HU0.540.0010.290.0370.65<0.0010.47<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.

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            Quantity and quality of antigravity muscles in patients undergoing living-donor lobar lung transplantation: 1-year longitudinal analysis using chest computed tomography images
            Yohei Oshima, Susumu Sato, Toyofumi F. Chen-Yoshikawa, Yuji Yoshioka, Nana Shimamura, Ryota Hamada, Manabu Nankaku, Akira Tamaki, Hiroshi Date, Shuichi Matsuda
            ERJ Open Research Apr 2020, 6 (2) 00205-2019; DOI: 10.1183/23120541.00205-2019

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            Quantity and quality of antigravity muscles in patients undergoing living-donor lobar lung transplantation: 1-year longitudinal analysis using chest computed tomography images
            Yohei Oshima, Susumu Sato, Toyofumi F. Chen-Yoshikawa, Yuji Yoshioka, Nana Shimamura, Ryota Hamada, Manabu Nankaku, Akira Tamaki, Hiroshi Date, Shuichi Matsuda
            ERJ Open Research Apr 2020, 6 (2) 00205-2019; DOI: 10.1183/23120541.00205-2019
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