title: Sarcopenia in lung transplantation: a systematic review.
abstract: Lung transplant candidates and recipients have significant impairments in skeletal muscle mass, strength and function--individual measures of sarcopenia. Skeletal muscle dysfunction has been observed in the pre-transplant and post-transplant period and could have an important effect on transplant outcomes. A systematic review was performed to characterize the techniques used to study sarcopenia and assess the level of impairment throughout the transplant process. Electronic databases were searched (inception to July 2013) for prospective studies measuring at least 1 element of sarcopenia (muscle mass, strength, or function) in lung transplant patients. Eighteen studies were included, and study quality was assessed using the Downs and Black scale. A variety of measurements were used to evaluate sarcopenia in 694 lung transplant patients. Muscle mass in 7 studies was assessed using bioelectrical impedance (n = 4), computed tomography or magnetic resonance imaging (n = 2), or skin folds (n = 1), and was significantly reduced. Quadriceps strength was examined in 14 studies with computerized dynamometer (n = 10) and hand-held dynamometer (n = 4). Quadriceps strength was reduced in the pre-transplant period (mean range, 49%-86% predicted; n = 455 patients), further reduced immediately after transplant (51%-72%, n = 126), and improved beyond 3 months after transplant (58%-101%, n = 164). Only 2 studies measured lower extremity function (sit-to-stand test). A multitude of measurement techniques have been used to assess individual measures of sarcopenia, with reduced muscle mass and quadriceps strength observed in the pre-transplant and post-transplant period. Further standardization of measurement techniques is needed to assess the clinical effect of sarcopenia in lung transplantation.
authors.affiliation: Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Respirology, Toronto General Hospital, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada. Electronic address: dmitry.rozenberg@uhn.ca.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Rozenberg
authors.affiliation: Toronto Lung Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Wickerson
authors.affiliation: Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Respirology, Toronto General Hospital, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Lianne G
authors.initials: LG
authors.lastname: Singer
authors.affiliation: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sunita
authors.initials: S
authors.lastname: Mathur
mesh_terms: D000328:Adult; D006801:Humans; D016040:Lung Transplantation; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D015995:Prevalence; D055948:Sarcopenia / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed
keywords: lung transplantation; muscle function; muscle mass; muscle strength; sarcopenia; skeletal muscle