Kev cuam tshuam ntawm sarcopenia ntawm Simultaneous Pancreas Thiab raum Transplantation Outcomes: Ib Retrospective Observational Cohort Study

Raphael PH Meier, MD, Ph.D.,1,2 Hiroshi Noguchi, MD,1,3 Yvonne M. Kelly, MD,1 Minnie Sarwal, MD, Ph.D.,1 Giulia Conti, MSc,1 Casey Ward, MD, 1 Ran Halleluyan, MD, 1 Mehdi Tavakol, MD, 1 Peter G. Stock, MD, Ph.D., 1 thiab Chris E. Freise, MD1

Keeb kwm.

Sarcopenia tau raug txheeb xyuas raws li qhov kev kwv yees sib txawv rau qhov tshwm sim ntawm kev phais. Peb xav tias sarcopenia tuaj yeem yog ib qho kev ntsuas tseem ceeb los txheeb xyuas cov neeg mob uas tsis muaj zog thiab muaj peev xwm kwv yees cov txiaj ntsig tsis zoo ntawm cov neeg tau txais cov kab mob pancreas ib txhij thiabraum(SPK) hloov pauv. Cov txheej txheem. Peb kwv yees sarcopenia los ntawm kev ntsuas psoas leeg nqaij index (PMI). PMI tau soj ntsuam ntawm perioperative computed tomography (CT) scans ntawm SPK cov neeg tau txais. Cov txiaj ntsig. Ntawm 141 tus neeg mob tau txheeb xyuas ntawm 2010 thiab 2018, 107 muaj CT scan muaj thiab tau suav nrog hauv txoj kev tshawb no. Qhov nruab nrab kev soj ntsuam yog 4 xyoo (ntau, 0.5–9.1 y). Nees nkaum-peb tus neeg mob muaj PMI qis, thiab 84 tus neeg mob muaj PMI ib txwm. Cov yam ntxwv ntawm tus neeg mob tau zoo sib xws ntawm 2 pawg tshwj tsis yog lub cev qhov hnyav, uas yog qhov qis dua hauv pawg PMI qis (P<0.001). patient="" and="">raumgraft survival tsis sib txawv ntawm cov pab pawg (P{{0}}}.851 thiab P=0.357, feem). Kev txheeb xyuas ntau yam ntawm Cox regression tau pom tias cov neeg mob uas muaj PMI qis yog 6 npaug ntau dua yuav poob lawv cov kab mob pancreas allograft (kev phom sij, 5.4; 95 feem pua ​​​​ntawm kev ntseeg siab, 1.4-20.8; P=0. 015). Peb ntawm 6 tus neeg mob tau poob lawv cov kab mob pancreas vim qhov tsis lees paub hauv pawg PMI qis, piv nrog 1 ntawm 9 tus neeg mob hauv pawg PMI ib txwm. Ntawm cov neeg mob PMI qis uas tau soj ntsuam CT scan, 62.5 feem pua ​​(5/8) ntawm cov neeg mob pancreas graft tau txhim kho lossis kho sarcopenia, thaum 75.0 feem pua ​​(3/4) ntawm cov neeg uas poob lawv cov kab mob pancreas txuas ntxiv mus. poob cov leeg nqaij.

Xaus.Sarcopenia tuaj yeem sawv cev rau ib qho ntawm cov kev kwv yees ntawm kev ua tsis tiav ntawm pancreas graft thiab yuav tsum tau soj ntsuam thiab ua kom zoo dua hauv SPK cov neeg tau txais kev pab.

Yog xav paub ntxiv thov hu rau:emily.li@wecistanche.com

Cistanche tubulosa tiv thaiv kab mob raum

Taw qhia

Simultaneous pancreas thiabraumKev hloov pauv (SPK) tseem yog qhov kev xaiv zoo tshaj plaws rau cov neeg mob ntshav qab zib hom 1 thiab xaiv cov neeg mob ntshav qab zib hom 2 nrogmob raum mob.1 Tom qab cov neeg mob kov yeej thawj 3-6 lub hlis tom qab hloov pauv, cov txiaj ntsig tau zoo heev: lub neej zoo rov qab los,raumgraft muaj nuj nqi tseem khaws cia ua tsaug rau lub xeev euglycemic rov qab thiab tus neeg mob

Kev ciaj sia tau zoo dua qub.2,3 Cov laj thawj rau kev poob qis ntawm pancreas graft yog multifactorial, nrog rau kev siv tshuab thiab vascular teeb meem, xau, pancreatitis, mob hnyav thiab mob ntev, thiab rov tshwm sim ntawm hom 1 lossis 2 mob ntshav qab zib. Ntxiv rau cov xwm txheej tseem ceeb uas tau piav qhia txog kev poob qis, suav nrog lub hnub nyoog pub dawb / tus neeg txais thiab lub cev qhov ntsuas (BMI), lub sijhawm mob khaub thuas ischemia, thiab hom kev tiv thaiv kab mob, 4 muaj qee qhov kev hloov pauv ntawm kev txiav txim siab ntawm cov kab mob qog noj ntshav. Hauv cov neeg mob ntshav qab zib mellitus nrog rau theem kawg ntawm lub raum, cov kev ntsuas lub hom phiaj xws li sarcopenia tau txais txiaj ntsig los kwv yees kev ua haujlwm thiab kev pheej hmoo ntawm cov teeb meem tom qab hloov pauv. Kev ntsuas psoas cov leeg nqaij ntawm cov duab hla ntu.9 Nws tau raug lees paub tias yog ib qho tseem ceeb ntawm kev kwv yees ntawm cov neeg tsis zoo thiab tau cuam tshuam nrog cov teeb meem, kev mob nkeeg, thiab kev tuag tom qab kev phais loj.10-13 Fukuda thiab al tsom xam lub luag haujlwm ntawm sarcopenia Hauv 41 tus neeg tau txais SPK thiab tau tshaj tawm qhov tsis tseem ceeb ntawm kev sib koom nrog qis psoas leeg nqaij qhov Performance index (PMI) thiab pancreas graft survival.6 Lawv tau ua, txawm li cas los xij, qhia txog kev sib koom ua ke ntawm cov leeg pob txha zoo (ib qho kev ntsuas ntawm sarcopenia) thiab ob qho tib si pancreas graft survival thiab postoperative teeb meem. Ntawm qhov tsis sib xws, lwm txoj kev tshawb fawb qhia tias PMI qis yuav muaj kev tiv thaiv; Txawm li cas los xij, cov lej tau tsawg heev thiab raug rau hom I yuam kev.1

Yog li ntawd, peb tau tshawb xyuas qhov cuam tshuam ntawm sarcopenia hauv cov neeg mob loj dua uas tau txais SPK allograft.

Cov khoom siv thiab cov txheej txheem

Cov neeg mob

Tag nrho ntawm 141 tus neeg mob tau txais SPK thaum Lub Kaum Hli 2010 thiab Lub Xya Hli 2018 ntawm University of California, San Francisco. Cov neeg mob tau taug qab mus txog lub Kaum Ob Hlis 2019. Tsis muaj kev hloov pauv hauv pawg neeg no. Cov neeg mob uas tsis muaj kev soj ntsuam tomography (CT) muaj (n=34) raug tshem tawm los ntawm kev tshuaj xyuas. Cov yam ntxwv ntawm tus neeg mob, cov ntaub ntawv pej xeem, pancreas thiabraummuaj nuj nqi, tus neeg mob thiab tag nrho kev noj qab haus huv muaj sia nyob (piv txwv li, tsis muaj neeg tuag censored graft survival), thiab cov ntaub ntawv pub dawb tuag tau sau los ntawm daim ntawv tshuaj xyuas, cov ntaub ntawv tswj hwm, thiab United Network for Organ Sharing database. Pancreas Donor Risk Index tau xam raws li tau piav qhia yav dhau los.15 Kev ncua sij hawm graft tau txhais tias cov neeg mob xav tau hemodialysis thawj lub lim tiam tom qab hloov pauv. Kev kis kab mob tau txhais tias yog cov tsos mob ntawm tus kab mob thiab yuav tsum tau mus pw hauv tsev kho mob tsis pub dhau 6 lub hlis tom qab hloov pauv (xws li kab mob urinary, kab mob hauv chaw phais, abscesses, mob ntsws, thiab sepsis).Lub raumthiab pancreas rejection tau txhais raws liraumthiab cov txiaj ntsig ntawm pancreas biopsy.Lub raumgraft tsis ua hauj lwm txhais tau tias yog rov qab mus rau kev lim ntshav los yog tus neeg mob tuag. Pancreas graft tsis ua haujlwm tau txhais tau tias yog kev rov pib kho cov tshuaj insulin lossis tus neeg mob tuag. Txoj kev tshawb no tau pom zoo los ntawm Pawg Saib Xyuas Kev Tshawb Fawb Tib Neeg ntawm University of California, San Francisco, thiab ua tau raws li cov txheej txheem zam kev tso cai.

Kev suav ntawm Psoas Muscle Index

PMI was measured on a perioperative CT scan performed either within 2.8 years before transplant (n=31) or up to 2.3 months after transplant (n=76). Among the 31 patients with a preoperative CT, 22 (71%) had a CT >1 xyoo ua ntej hloov. Ntawm 76 tus neeg mob uas muaj CT tom qab phais, 41 (54 feem pua) muaj CT hauv 2-lub lis piam tom qab hloov pauv. CT cov duab ntawm qib plaub / tsib lub lumbar vertebrae thiab Image J software (National Institute of Health, Bethesda, MD) tau siv los ntsuas qhov chaw hla ntawm sab xis thiab sab laug psoas cov leeg. Kev ntsuas tau ua los ntawm HN thiab RPHM, qhov muag tsis pom ntawm pawg neeg ua haujlwm thiab cov txiaj ntsig. Lub PMI tau muab xam raws li cov lus cog tseg yav dhau los tau piav qhia 6,14: PMI raws li qhov chaw hla ntawm ob sab psoas leeg 2 / qhov siab 2 (cm2 / m2 ). Vim tias qhov ntau ntawm PMI hauv cov txiv neej thiab poj niam sib txawv, PMI qis tau txhais tias yog qhov qis tshaj plaws rau cov txiv neej thiab poj niam sib cais. Peb faib cov neeg tau txais kev pab ua 2 pawg siv cov nqi qis qis raws li qhov pib sib cais cov neeg mob uas muaj PMI ib txwm muaj los ntawm cov neeg uas muaj PMI qis (ib txwm PMI hauv cov txiv neej thiab poj niam yog siab dua lossis sib npaug li 7.43 thiab ntau dua lossis sib npaug li 6.20cm2 / m2, ntsig txog; PMI qis hauv txiv neej thiab poj niam yog<7.43 and=""><6.20cm2 2,="" respectively).="" in="" patients="" with="" a="" low="" pmi,="" we="" identified="" those="" with="" a="" follow-up="" ct="" scan="" of="" the="" abdomen="" and="" measured="" a="" follow-up="" pmi="" in="" these="" patients="" (n="">

Kev Tshawb Fawb Txog Kev Tshawb Fawb

Cov txiaj ntsig tau nthuav tawm raws li qhov txhais tau tias ± SD thiab suav thiab feem pua ​​​​ntawm cov kev hloov pauv tshwj tsis yog tau teev tseg. Qhov sib txawv ntawm pawg tau txheeb xyuas nrog t-test rau qhov sib txawv tsis tu ncua thiab Chi-square test rau binary thiab categorical variables. Kev soj ntsuam ciaj sia taus tau ua nrog txoj kev Kaplan-Meier, thiab pab pawg tau muab piv nrog kev ntsuas ntsuas ntsuas. Kev ua tsis tiav thaum ntxov (hauv thawj 40 d) tsis suav nrog kev txheeb xyuas tus kab mob pancreas ciaj sia (n=2). Univariate thiab multivariate Cox proportional-hazards regression tau siv los xam qhov phom sij txaus ntshai. Variables nrog P<0.10 in="" the="" univariate="" analysis="" were="" included="" in="" the="" multivariate="" analysis.="" correlations="" and="" corresponding="" p="" values="" were="" assessed="" using="" linear="" regression.="" ninety-five="" percent="" confidence="" intervals="" were="" reported,="" and="" an="" exact="" 2-sided=""><0.05 was="" considered="" statistically="" significant.="" statistical="" data="" and="" graphs="" were="" generated="" using="" spss="" version="" 24.0="" (spss,="" chicago,="" il)="" and="" prism="" version="" 8="" (graphpad,="" san="" diego,="">

TSEEM CEEB

Cov yam ntxwv tseem ceeb thiab cov txiaj ntsig luv luv

Tag nrho ntawm 107 cov neeg mob tau raug muab rau pawg PMI qis (qis tshaj quartile, n=23) lossis pawg PMI ib txwm (sab saum toj kawg nkaus quartile, n=84). Qhov nruab nrab, CT scan tau ua 2.0 ± 5.9 thiab 2.3 ± 6.9 lub hlis ua ntej kev phais hauv pawg PMI qis thiab siab, raws li (P=0.820). Cov yam ntxwv ntawm tus neeg mob thiab tus neeg pub dawb tau pom nyob rau hauv Table 1. Tus neeg txais BMI tau qis dua hauv pawg PMI qis piv nrog rau pawg PMI ib txwm (22.5 ± 3.8 piv rau 25.8 ± 3.3kg / m2, P<0.001), and="" a="" weak="" correlation="" was="" identified="" between="" pmi="" and="" bmi="" (r2="0.107,"><0.001) (figure="" 1a).="" all="" the="" other="" baseline="" characteristics="" were="" not="" statistically="" different="" between="" the="" 2="" groups.="" panel-reactive="" antibody="" (pra),="" hla="" mismatches,="" and="" preoperative="" donor-specific="" antibodies="" were="" not="" statistically="" different="" between="" groups;="" all="" recipients="" received="" thymoglobulin="" and="" steroids="" for="" induction,="" and="" baseline="" maintenance="" immunosuppression="" was="" similar="" between="" the="" 2="" groups.="" preoperative="" serum="" albumin="" was="" not="" correlated="" with="" pmi="" (figure="" 1b).="" diabetes="" duration="" and="" preoperative="" hba1c="" were="" also="" not="" different="" between="" the="" low="" and="" normal="" pmi="" groups.="" patient="" and="" transplant="" outcomes="" are="" presented="" in="" table="" 2.="" the="" median="" follow-up="" was="" 4="" years="" in="" both="" groups="" (p="0.365)." short-term="" outcomes="" including="" surgical="" complications="" (assessed="" using="" the="" clavien-dindo="" score16),="" delayed="" graft="" function,="" rejection,="" infection,="" and="" length="" of="" hospital="" stay="" were="" not="" statistically="" different="" between="">

Pancreas Graft Survival Zuag qhia tag nrho,

pancreas graft ciaj sia yog 83.4 feem pua ​​​​ntawm 5 xyoo. Peb tau pom tias cov neeg mob hauv pab pawg PMI qis tau txo qis cov kab mob pancreas graft ciaj sia piv nrog cov neeg mob hauv pawg PMI ib txwm (P=0.031) (Daim duab 2A). Cov ciaj sia taus yog 79.9 feem pua ​​​​thiab 86.7 feem pua ​​​​ntawm 5 xyoo hauv cov pab pawg PMI qis thiab ib txwm, raws li. Yog li, hemoglobin A1c thaum kawg kev soj ntsuam tau siab dua hauv cov neeg mob uas tsis tshua muaj PMI; Txawm li cas los xij, qhov sib txawv ntawm cov pab pawg tsis tau tshwm sim ntxiv lawm tom qab kev cais tawm ntawm cov neeg mob uas ua tsis tau tiav pancreas allografts (Table 2). Kev soj ntsuam rhiab heev piv rau cov neeg mob nrog thiab tsis muaj CT scan ua ntej lossis tom qab kev phais tsis pom qhov txawv ntawm cov kab mob pancreas graft survival (Daim duab S1A thiab S1B, SDC, http://links.lww.com/TXD/A279). Ntawm 6 tus kab mob qog noj ntshav hauv cov pab pawg PMI qis, 3 yog vim tsis lees txais, thiab 2 yog vim ntshav qab zib rov tshwm sim, thaum ntawm 9 qhov kev poob qis hauv pawg PMI ib txwm, 3 yog vim muaj teeb meem vascular, thiab 1 yog vim yog kev tsis lees paub (Table 3). Cov kev kwv yees ntawm cov txiaj ntsig ntawm kev muaj sia nyob tau raug tshuaj xyuas hauv Cox regression qauv (Table 4). Hauv kev txheeb xyuas qhov tsis sib xws, poj niam txiv neej, poj niam txiv neej dub lossis African Asmeskas haiv neeg, PRA siab dua, thiab PMI qis tau cuam tshuam nrog pancreas allograft tsis ua haujlwm. Nco ntsoov, tus neeg tau txais BMI qis tsis cuam tshuam nrog kev txo qis hauv pancreas graft survival (Table 4 thiab daim duab S1C, SDC, http://links.lww. com/TXD/A279). Txhua qhov kev hloov pauv nrog P<0.1 in="" the="" univariate="" analysis="" were="" then="" included="" in="" the="" multivariate="" cox="" regression.="" patients="" with="" a="" low="" pmi="" were="" 5="" times="" more="" likely="" to="" lose="" their="" pancreas="" allograft="" (hazard="" ratios,="" 5.4;="" 95%="" confidence="" intervals,="" 1.4-20.8;="" p="0.015)," and="" pmi="" was="" the="" only="" independent="" significant="" predictor="" in="" the="" multivariate="" analysis="" among="" the="" significant="" variables="" in="" the="" univariate="" analysis="" (ie,="" gender,="" race,="" pra,="" steroid="" use,="" pmi,="" and="">Lub raumTus neeg pub khoom Profile Index) (Table 4).

Evolution ntawm Sarcopenia Tom Qab Hloov

Peb tau txheeb xyuas 12 tus neeg mob hauv pawg PMI qis uas muaj kev soj ntsuam CT ntawm lub plab. Kev soj ntsuam CT tom qab tau txais 3.0± 2.8 xyoo tom qab hloov pauv. Ntawm cov neeg mob uas tau nce mus rau lub txiav ua haujlwm tsis ua haujlwm, 75%. ntawm kev rov qab los (Daim duab 3). Ob tug neeg mob uas pib PMI qis thiab tsis tau poob lawv cov graft muaj kev txhim kho hauv lawv cov sarcopenia tom qab hloov pauv thiab muaj PMI ib txwm nyob rau qhov kawg ntawm kev soj ntsuam (Daim duab 3, cov neeg mob 5 thiab 7). Interestingly, BMI qhov sib txawv ntawm ib txwm thiab qis PMI pawg pom ua ntej hloov pauv tau raug kho ib nrab tom qab hloov pauv (Table 2). Tsis muaj qhov sib txawv hauvraumlos yog pancreas graft survival tau pom ntawm cov neeg mob uas tsis muaj kev soj ntsuam CT scan (Daim duab S2A thiab S2B, SDC, http://links.lww.com/TXD/A279).

Lub raum Graft Ciaj sia nyob thiab tag nrho cov ciaj sia taus

Zuag qhia tag nrhoraumGraft ciaj sia yog 91.7 feem pua ​​​​ntawm 5 xyoo. Cov qib creatinine tsis txawv ntawm cov pab pawg thaum kawg ntawm kev ua raws (Table 2). Covraumciaj siatus nqi tsis cuam tshuam los ntawm qhov pib PMI (Daim duab 2B). Tag nrho cov neeg mob muaj sia nyob yog 95.4 feem pua ​​​​ntawm 5 xyoos. Tsis muaj qhov sib txawv tseem ceeb hauv cov neeg mob muaj sia nyob tau pom ntawm pawg PMI qis thiab ib txwm muaj (Daim duab 2C).

Kev sib tham

Hauv txoj kev tshawb fawb tam sim no, peb tau ntsuas cov leeg nqaij hauv SPK cov neeg tau txais kev hloov pauv los txheeb xyuas cov kev sib raug zoo ntawm sarcopenia thiab cov txiaj ntsig tom qab hloov pauv. Peb pom tias PMI qis hauv SPK cov neeg tau txais txiaj ntsig tau cuam tshuam nrog kev txo qis ntawm cov kab mob pancreas mus ntev. Kev tsis lees paub thiab ntshav qab zib rov tshwm sim yog qhov ua rau mob pancreas graft poob hauv cov neeg tau txais nrog qis psoas nqaij index.Lub raumgraft survival thiab tag nrho cov neeg mob ciaj sia tsis tau cuam tshuam los ntawm qhov pib PMI.

Sarcopenia txhais tau tias yog qhov poob ntawm pob txha pob txha loj thiab kev ua haujlwm17 thiab cuam tshuam nrog frailty, kev tuag, thiab cov txiaj ntsig tsis zoo hauv cov neeg mob phais thiab tsis phais.18 Frailty yog txhais los ntawm qhov muaj 3 ntawm cov khoom hauv qab no: lub zog tuav qis, qis. lub zog, qeeb taug kev nrawm, tsis muaj lub cev ua si, thiab poob phaus.19 Cov yam tseem ceeb rau sarcopenia muaj xws li hnub nyoog, poj niam txiv neej, theem ntawm kev ua ub ua no, tsis muaj zaub mov noj, thiab ntau yam kev mob comorbid.17,18,20 Interestingly, type 1 diabetes yog txuam nrog sarcopenia los ntawm kev tsub zuj zuj ntawm cov khoom siab tshaj glycation kawg.21 Sarcopenia yav dhau los tau pom tias muaj feem cuam tshuam nrog kev tuag ntau dua tom qab hloov daim siab, 5,22 nyob tus neeg pub lub siab hloov pauv, 7 thiab kho lub plab aortic aneurysm, 23 nrog rau kev pheej hmoo ntawm kev mob ntshav qab zib ntau dua. thiab ncua kev rov qab los ntawm kev phais mob qog nqaij hlav hauv plab hnyuv 24 thiab laparotomy.

Peb cov txiaj ntsig tau zoo ib yam nrog cov kev tshawb fawb yav dhau los uas txuas cov leeg pob txha zoo, suav nrog cov ntaub so ntswg intramuscular (psoas) adipose cov ntaub so ntswg, ua rau muaj kev pheej hmoo siab dua ntawm cov teeb meem tom qab phais thiab qhov tsis zoo ntawm cov kab mob pancreas graft survival.6 Cov kws sau ntawv tau tshaj tawm tias cov neeg tau txais PMI qis dua. muaj tus kab mob pancreas qis; Txawm li cas los xij, qhov sib txawv tsis yog qhov tseem ceeb, tej zaum vim muaj cov neeg koom nrog hauv txoj kev tshawb no tsawg. Nrog cov pab pawg loj dua, peb pom muaj kev sib koom ua ke tseem ceeb ntawm PMI qis thiab qhov tsis zoo ntawm cov kab mob pancreas graft survival. Qhov kev soj ntsuam no tau lees paub ntxiv hauv peb cov qauv multivariate. Qhov sib txawv tau pom nyob rau hauv nruab nrab-rau-ntev-ntev ciaj sia taus thiab qhia tias sarcopenia pheej tshwm sim tom qab hloov pauv. Cov ntaub ntawv ntawm cov neeg uas tau soj ntsuam CT scan tom qab hloov pauv ntxiv txhawb qhov kev xav no: 62.5 feem pua ​​(5/8) ntawm cov neeg mob uas muaj PMI qis qis thiab kev ua haujlwm tsis zoo ntawm qhov kawg ntawm kev ua raws li kev txhim kho PMI (37.5). feem pua ​​) lossis daws sarcopenia (25.0 feem pua ​​). Ntawm qhov tod tes, 75%. Hauv Cox univariate tsom xam, sarcopenia, poj niam txiv neej, poj niam txiv neej, Dub lossis African American haiv neeg, 4 thiab siab dua PRA tau cuam tshuam nrog qis qis qis qis qis. Tus qauv multivariate Cox tau qhia txog lub luag haujlwm tseem ceeb ntawm PMI, uas tseem yog tus kws tshaj lij ntawm kev noj qab haus huv ntawm tus txiav hauv peb cov qauv. Qee lwm yam tseem ceeb uas muaj kev pheej hmoo rau kev ua tsis tiav tom qab SPK suav nrog cov hnub nyoog hluas, BMI tshaj 30kg / m2, cov hnub nyoog laus dua, thiab lub sijhawm khaws cia ntev dua.4 Peb tsis tuaj yeem hais txog tag nrho lawv hauv peb pawg, tej zaum vim tsis muaj ntawm lub zog. Qhov zoo siab, peb pom qhov tsis muaj kev sib raug zoo ntawm tus neeg txais PMI thiab BMI. Ib tus tuaj yeem nug seb tus neeg tau txais BMI puas tuaj yeem ua tus kwv yees ntawm pancreas graft survival thiab. Nyob rau hauv daim ntawv teev npe tshawb fawb ntawm Kev Hloov Cov Neeg Txais Cov Ntaub Ntawv, zoo ib yam li cov rog, rog (BMI)<18.5kg 2="" )="" was="" associated="" with="" unfavorable="" outcomes="" after="" spk.26="" this="" report="" is="" in="" line="" with="" our="" correlation="" between="" bmi="" and="" pmi,="" and="" the="" detrimental="" roles="" of="" sarcopenia="" and="" frailty="" as="" shown="" by="" us="" and="" others.27="" we="" could="" not="" highlight="" a="" significant="" association="" between="" low="" bmi="" and="" pancreas="" graft="" survival="" (possibly="" because="" only="" 3="" recipients="" had="" a=""><18.5kg 2="" in="" our="">

Muab peb qhov kev tshawb pom, peb ntseeg tias sarcopenia tuaj yeem sawv cev rau qhov tseem ceeb ntawm kev kwv yees uas yuav tsum tau ntsuas hauv SPK cov neeg sib tw. Tam sim no, txhua tus neeg mob SPK tau teev nyob rau hauv peb lub chaw tau txais qhov tsis sib xws CT scan los ntsuas PMI; peb nyob rau hauv tus txheej txheem ntawm kev siv qhov ntsuas ntawm tuav lub zog, lub sij hawm lub rooj zaum stands, thiab sib npaug ntsuam xyuas los kwv yees frailty. Qhov no tuaj yeem muaj qhov cuam tshuam tseem ceeb vim tias qhov kev txheeb xyuas ua ntej ntawm sarcopenia yuav tso cai rau kev cuam tshuam ntawm cov kev pheej hmoo uas yuav hloov tau. Ntawm qhov kev ceeb toom, kev kawm ua haujlwm tsis zoo thiab kev hloov pauv khoom noj khoom haus sawv cev rau cov kev cuam tshuam zoo rau kev thim rov qab sarcopenia.28 Kev cuam tshuam zoo ntawm sarcopenia yuav muaj cai rau kev tswj hwm ntawm lwm yam kev pheej hmoo zoo xws li hnub nyoog tau txais, BMI, hnub nyoog pub dawb, thiab lub sijhawm khaws cia.

Cov txheej txheem uas sarcopenia cuam tshuam nrog qis pancreas ciaj sia tseem yuav tau piav qhia. Muab cov xwm txheej tsawg, nws yog ib qho nyuaj rau kev xav txog qhov muaj peev xwm txuas ntawm sarcopenia thiab pancreas graft poob. Pancreas graft poob yog feem ntau multifactorial, thiab tshwm sim los ntawm ntau yam teeb meem tshwm sim. Nws yog qhov ua tau tias cov neeg mob sarcopenic raug kev txom nyem ntau dua (xws li mob hnyav dua tom qab phais mob, kab mob subclinical, kev tsis lees paub, thiab lwm yam), uas ua rau txo qis ntawm pancreas graft lifespan. Qhov kev nce qib ntawm "tseem ceeb" no yog ua raws li qhov qeeb thiab maj mam muaj sia nyob qhov sib txawv pom ntawm pawg PMI qis thiab ib txwm muaj. Cov kev sib txawv me ntsis no tuaj yeem piav qhia ntxiv los ntawm qhov tseeb tias cov neeg mob tuaj yeem tswj hwm tus kab mob normoglycemia kom txog thaum lig dhau ntawm cov txheej txheem ntawm graft poob, zam kev poob txog li 80 feem pua ​​​​ntawm lawv cov beta-cell mass.29 Nyob rau hauv peb pawg, tag nrho cov teeb meem tsis tau txheeb xyuas. sib txawv ntawm pawg. Txawm li cas los xij, cov teeb meem loj heev (piv txwv li, Clavien-Dindo Ntau dua lossis sib npaug li 3b) tau ntau dua nyob rau hauv pawg PMI qis (21.6 feem pua ​​​​vim 15.5 feem pua). Ntawm qhov tod tes, cov teeb meem tsis tshua muaj tshwm sim ntau zaus hauv pawg PMI ib txwm (59.4 feem pua ​​​​vim 39.1 feem pua).

Peb tau pom tias 3 ntawm 6 tus kab mob pancreas tsis ua haujlwm yog vim kev tsis lees paub hauv pawg PMI qis. Qhov no yog raws li qhov peb tau pom yav dhau los hauv cov neeg tau txais daim siab hloov pauv, uas qhov kev tsis txaus ntseeg tau cuam tshuam nrog nce tus nqi ntawm cov cellular rejection.30 Muaj peev xwm ua rau cov kev tsis lees paub ntau dua no txhais tau tias cov neeg mob tsis muaj zog muaj zog ntxiv rau lub xeev 31 thiab zoo li yuav muaj tus nqi siab dua. mycophenolate koob tshuaj txo qis dua li cov neeg txais tsis muaj zog.30 Hauv lwm lo lus, ib tus tuaj yeem xav tias cov neeg mob PMI qis tau txais kev tiv thaiv kab mob tsawg dua vim tias pawg tswj hwm muaj ntau dua los txo cov koob tshuaj kom tsis txhob muaj teeb meem overimmunosuppression-txog cov teeb meem hauv cov neeg mob qaug zog no.

Lwm qhov kev piav qhia tseem ceeb ntawm kev siv tshuab yog tias cov leeg nqaij nws tus kheej thiab kev tawm dag zog muaj kev tiv thaiv ncaj qha rau -cells ciaj sia taus thiab kev ua haujlwm.32 Ntawm kev ceeb toom, sarcopenia tau pom tias ua rau muaj kev rog rog cuam tshuam nrog insulin tsis kam thiab dysglycemia.33,34 Kev tso tawm ntawm interleukins { {5}} los ntawm cov leeg tau pom tias yog ib qho tseem ceeb ntawm kev sib kho ntawm cov nyhuv no.32,35,36 Lwm qhov tseem ceeb yog fibroblast kev loj hlob zoo tshaj 21, paub txog -cell tiv thaiv qhov tseem ceeb, uas yog secreted los ntawm cov leeg hauv cov lus teb rau insulin. .37 Nyob rau hauv cov lus teb rau saturated fatty acids, cov leeg kuj tsim irisin, uas, thaum noj nyob rau hauv vivo, txhawb -cell ciaj sia taus thiab enhanced qabzib-stimulated insulin secretion.38 Xav txog qhov kev sib tham ntawm no sib tham ntawm myocytes thiab hlwb, nws kuj yog nthuav kom nco ntsoov. hais tias nyob rau hauv sib piv nrog pancreas-txog cov txiaj ntsig, sarcopenia tsis cuam tshuam nrograumkev noj qab haus huv nyob rau hauv peb pawg. Qhov no tej zaum yuav muaj feem xyuam rau qhov tseeb tiasraumgrafts feem ntau muaj kev ciaj sia zoo dua piv nrog pancreas grafts. Kev sib txuas ntawm catabolism thiab qabzib homeostasis tuaj yeem ua rau pancreas rhiab dua piv nrograum. Peb tsis tau pom qhov sib txawv tseem ceeb ntawm tag nrho cov neeg mob muaj sia nyob ntawm PMI qis thiab cov neeg mob PMI ib txwm muaj. Tag nrho cov neeg tuag tsawg tsawg hauv peb pawg pab pawg tuaj yeem tiv thaiv peb los ntawm kev soj ntsuam qhov sib txawv tseem ceeb.

Txoj kev tshawb fawb tam sim no muaj qee qhov kev txwv. Ua ntej, peb tshaj tawm txog ib pawg me me ntawm cov neeg mob los ntawm ib lub chaw hloov pauv ib leeg, thiab qhov rov qab los ntawm peb txoj kev tshawb fawb tsis tso cai rau cov lus txiav txim siab ntawm causality. Nrog rau qhov tsawg kawg nkaus ntawm cov xwm txheej no, cov txiaj ntsig, tshwj xeeb tshaj yog hais txog qhov ua rau pancreatic graft poob, yuav tsum tau txhais nrog ceev faj. Cov kev tshawb fawb ntxiv nrog rau cov ntaub ntawv multicenter tau lees paub los lees paub qhov cuam tshuam ntawm sarcopenia hauv lub tebchaws no. Qhov thib ob, muaj kev txwv tsis pub muaj kev tsis ncaj ncees hauv pawg kawm vim peb tsuas yog suav nrog cov neeg mob nrog CT scan ntawm lub plab hauv lub sijhawm perioperative (n=107), txawm hais tias cov neeg mob tsis suav nrog ib feem tsawg (19.9 feem pua, 28/ 141). Nrog rau kev soj ntsuam rhiab heev, peb pom tias pancreas graft survival tsis txawv ntawm cov neeg mob thiab tsis muaj CT scan. Tsis tas li ntawd, peb tsuas yog piv cov kev muaj sia nyob ntawm cov neeg mob uas muaj CT scan ntawm lub plab, thiab peb cov lus xaus yuav tsum, yog li ntawd, tseem siv tau. Peb kuj lees paub qhov tseeb tias tsis yog txhua qhov CT scan tau ua tiav tam sim ua ntej kev phais, uas yuav sawv cev rau lub sijhawm zoo rau kev ntsuas. Txawm li cas los xij, feem ntau ntawm CT scans tau ua ua ntej lossis tsis ntev tom qab kev phais, thiab tsis muaj qhov sib txawv hauv CT scan hnub ntawm pawg lossis qhov sib txawv hauv kev ua rau pancreas graft ciaj sia nrog CT scan hnub sib txawv. Ntxiv mus, sarcopenia yuav siv sij hawm rov qab, 39 thiab, thaum tsis muaj kev cob qhia ua ntej / perioperative resistance los yog kev noj zaub mov zoo, nws tsis zoo li yuav txhim kho ua ntej lossis tam sim tom qab hloov. Peb, yog li ntawd, ntseeg tias cov txiaj ntsig tau pom zoo sawv cev qhov kev kwv yees ntawm cov leeg nqaij ntawm kev hloov pauv hauv peb cov pej xeem. Nws tseem ceeb heev uas yuav tsum nco ntsoov tias hauv txoj kev tshawb no, peb piav qhia tsuas yog 1 feem ntawm frailty, uas yog, sarcopenia, hauv cov tub ntxhais hluas ntawm cov neeg mob. Peb lees paub tias qhov kev xav ntawm sarcopenia tau tsim thiab ntsuas zoo tshaj plaws hauv cov neeg laus. Cov kev tshawb fawb yav tom ntej yuav tuaj yeem sib sau ua ke ntau dua kev ntsuas ntawm sarcopenia thiab muaj peev xwm suav nrog kev cuam tshuam los daws qhov cuam tshuam ntawm cov leeg nqaij poob ua ntej hloov pauv.

Hauv kev xaus, sarcopenia tau cuam tshuam nrog txo qis pancreas graft ciaj sia nyob rau hauv cov neeg mob tau txais kev hloov pauv SPK. Qhov paub txog kev tiv thaiv lub luag haujlwm ntawm cov leeg nqaij txaus ntawm - kev ua haujlwm ntawm tes yuav piav qhia cov kev tshawb pom no. Kev txheeb xyuas qhov systematic ntawm sarcopenia hauv SPK cov neeg sib tw tuaj yeem pab txheeb xyuas cov neeg mob uas tsis muaj lub cev tsis muaj zog. Kev cuam tshuam nrog kev cob qhia kev tiv thaiv thiab kev hloov pauv khoom noj khoom haus tuaj yeem siv rau cov neeg mob uas cov leeg nqaij poob mus rau thim rov qab sarcopenia thiab muaj peev xwm txhim kho cov txiaj ntsig tom qab hloov pauv.

TXOJ CAI

Peb ua tsaug Anna Mello rau nws txoj kev pab nrog tus neeg mob database tswj.

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