Background:

Abnormal body mass index (BMI) (both <19 and >30 kg/m²) has been associated with worse outcomes in lung transplantation. However, this measurement cannot assess risks due to sarcopenia. Computed tomography (CT) imaging software is able to measure lean and obese tissue mass but has not been previously used in a lung transplant population. We sought to determine the utility of CT imaging software in this population.

Materials and Methods:

This study was approved by the IRB. Consenting lung transplant recipients prior to Jan 13, 2012 were considered for enrollment. Patients with CT scans within 6 months of transplant that included lumbar levels L3 were included. Digital Imaging and Communications in Medicine (DICOM) standard images were retrospectively analyzed with slice-o-matic software version 5.0 (TomoVision, Magog, Canada). Muscle tissue was measured using radiodensity and mass index was calculated at the L3 image level. Chart was abstracted for patient demographic, transplant details, and outcome data. Sarcopenia was defined as ≤ 38.5 cm²/m² for women and ≤52.5 cm²/m² for men.

Results: 32 patients (21 bilateral, 9 single, and 2 heart lung) were eligible for inclusion. Of these median age was 57 (range 21-67), 53% were male with a median BMI at transplant of 22.7 kg/m². Most common diagnosis was COPD (72%). 3 patients were underweight, 20 normal, 6 overweight, and 3 obese. Sarcopenia was present in all individuals regardless of BMI, age or gender. Muscle mass index ranged from 15.0 to 27.1 cm²/m² in women and 18.1 to 28.3 cm²/m² in men.

Conclusions:

Computer imaging software is able to identify sarcopenia in lung transplant recipients. All patients in this study had profound sarcopenia regardless of BMI or age. Future research is warranted to determine if sarcopenia can be ameliorated with pulmonary rehabilitation or other interventions.

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