ARRS 2022 Abstracts

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E1580. The Utility of Chest CT in Assessing Sarcopenia in Pre-operative Evaluation of Lung Transplant Candidates
Authors
  1. Ashley Hu; UCLA
  2. Ashley Prosper; UCLA
  3. Kathleen Ruchalski; UCLA
  4. Joanna Schaenman; UCLA
Objective:
Previous studies demonstrated an association between physical frailty, measured by Fried frailty phenotype (FFP), with waitlist death and length of stay after lung transplantation. We sought to evaluate the predictive ability of sarcopenia measured by CT in patients undergoing evaluation for lung transplantation. Pectoralis cross-sectional area and average muscle attenuation were used as surrogate markers for sarcopenia.

Materials and Methods:
An IRB-approved retrospective analysis was performed on 68 patients (age range 60–71 years) who had undergone frailty evaluations at our center and had a pre-transplant chest CT available for review. The cross-sectional area (in cm2) and average attenuation (in Hounsfield units, HU) of the pectoralis major muscle were obtained at the level of one slice above the aortic arch using the software OsiriX (Pixmeo, Geneva). These values were then analyzed in association with physical frailty assessments by FFP and short performance physical battery (SPPB), patient demographic characteristics, and clinical outcomes.

Results:
Sarcopenia, as measured by either pectoralis area or average attenuation, was not significantly associated with patient age and was not significantly associated with absolute physical frailty assessment scores, including both FFP and SPPB. However, the sarcopenia measurements showed statistically significant correlation with binarized FFP scores when classified into “frail” and “not frail” categories (p = 0.02). In addition, for patients who underwent transplantation during the period of study (n = 46), both pectoralis muscle area and attenuation were shown to be significantly associated with the length of stay after transplantation (p = 0.002 and p = 0.034, respectively).

Conclusion:
Sarcopenia represents an attractive method for patient assessment prior to lung transplantation because chest CT is routinely performed during pre-transplant evaluation and measurements can be done without additional patient effort or time. Although there was no direct association between sarcopenia and the absolute clinical assessment scores, sarcopenia demonstrated robust associations with frailty categorization and clinical outcome after lung transplantation. CT-based sarcopenia scores can potentially be used as a risk stratification measure alongside clinical frailty assessments during pre-transplant evaluation as different avenues to achieve the same goal of optimizing patient outcomes.