title: Core Muscle Size Predicts Postoperative Outcome in Lung Transplant Candidates.
abstract: BACKGROUND
  Careful patient selection is the prerequisite to raise transplant benefit. In lung transplant (LT) candidates, the effect of body mass index (BMI) on postoperative outcome remains controversial, possibly due to the inaccuracy of BMI in discriminating between fat and muscle mass. We therefore hypothesized that assessment of body composition by muscle mass measures is more accurate than by BMI regarding postoperative outcome.
  
  
  METHODS
  All LT recipients from 2011 to 2014 were included and retrospectively analyzed. Lean psoas area (LPA) was assessed from pretransplant computed tomography scans, and associations with postoperative outcomes were investigated.
  
  
  RESULTS
  Included were 103 consecutive LT recipients with a mean pre-LT BMI of 22.0 ± 4.0 kg/m(2) and a mean LPA of 22.3 ± 8.3 cm(2). LPA was inversely associated with length of mechanical ventilation (p = 0.03), requirement of tracheostomy (p = 0.035), and length of stay in the intensive care unit (p = 0.02), while controlling for underlying disease, BMI, sex, age, and procedure; in contrast, BMI was not (p = 0.25, p = 0.54, and p = 0.42, respectively.). Multiple regression analysis revealed that the 6-minute walk distance at the end of pulmonary rehabilitation was significantly associated with LPA (p = 0.02).
  
  
  CONCLUSIONS
  LPA can easily be assessed in LT candidates as part of pretransplant evaluation and was significantly associated with short-term outcome, whereas BMI was not. Assessment of LPA may provide additional information on body composition beyond BMI. However, the clinical utility has to be further evaluated.
authors.affiliation: Department of Anesthesiology, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL).
authors.forename: Thomas
authors.initials: T
authors.lastname: Weig
authors.affiliation: Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL).
authors.forename: Katrin
authors.initials: K
authors.lastname: Milger
authors.affiliation: Institute for Clinical Radiology, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL).
authors.forename: Birgit
authors.initials: B
authors.lastname: Langhans
authors.affiliation: Department of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL).
authors.forename: Silke
authors.initials: S
authors.lastname: Janitza
authors.affiliation: Transplant Center Munich, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL).
authors.forename: Alma
authors.initials: A
authors.lastname: Sisic
authors.affiliation: Department of Respiratory Medicine, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany, Member of the German Center for Lung Research (DZL).
authors.forename: Klaus
authors.initials: K
authors.lastname: Kenn
authors.affiliation: Department of Anesthesiology, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL).
authors.forename: Thomas
authors.initials: T
authors.lastname: Irlbeck
authors.affiliation: Institute for Clinical Radiology, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL).
authors.forename: Andreas
authors.initials: A
authors.lastname: Pomschar
authors.affiliation: Institute for Clinical Radiology, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL).
authors.forename: Thorsten
authors.initials: T
authors.lastname: Johnson
authors.affiliation: Department of Anesthesiology, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL).
authors.forename: Michael
authors.initials: M
authors.lastname: Irlbeck
authors.affiliation: Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL).
authors.forename: Jürgen
authors.initials: J
authors.lastname: Behr
authors.affiliation: Department of Anesthesiology, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL).
authors.forename: Stephan
authors.initials: S
authors.lastname: Czerner
authors.affiliation: Clinic of Cardiac Surgery, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL).
authors.forename: René
authors.initials: R
authors.lastname: Schramm
authors.affiliation: Department of Thoracic Surgery, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL).
authors.forename: Hauke
authors.initials: H
authors.lastname: Winter
authors.affiliation: Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL).
authors.forename: Claus
authors.initials: C
authors.lastname: Neurohr
authors.affiliation: Department of Anesthesiology, University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL).
authors.forename: Lorenz
authors.initials: L
authors.lastname: Frey
authors.affiliation: Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), University of Munich, Munich, Germany, Member of the German Center for Lung Research (DZL). Electronic address: nikolaus.kneidinger@med.uni-muenchen.de.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Kneidinger
mesh_terms: D000328:Adult; D001823:Body Composition; D015992:Body Mass Index; D003422:Critical Care; D005260:Female; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000473:pathology* / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D018579:Patient Selection; D011237:Predictive Value of Tests; D016658:Psoas Muscles / Q000033:anatomy & histology*; D012189:Retrospective Studies; D016896:Treatment Outcome