Association between pre-transplant psoas sarcopenia and perioperative outcomes in lung transplant recipients: a single-center retrospective cohort study

OBJECTIVES: Lung transplantation (LTx) is the solid organ transplantation with the comparatively worst prognosis. Therefore, improving candidate selection and risk stratification for these patients has become a high-priority research focus. Incorporating objective markers of frailty such as sarcopenia in the pre-transplant evaluation may help achieve this goal. We evaluated the association between CT-measured psoas muscle sarcopenia and early LTx outcomes. METHODS: We performed a retrospective study including patients who underwent LTx from 2014 to 2018 at our institution with available chest and abdominal CT scans in the year prior to LTx. Psoas cross-sectional area was measured, and previously established sex-specific cutoffs were used to define sarcopenia. We compared sarcopenic and non-sarcopenic LTx recipients regarding 1-year mortality and perioperative outcomes. RESULTS: A total of 140 patients were included, who received LTx primarily for interstitial lung disease (ILD) (n = 75, 53%) or chronic obstructive pulmonary disease (n = 54, 39%). Forty-six (33%) were sarcopenic. We found no association between psoas sarcopenia and 1-year all-cause mortality (multivariable p=0.13) nor perioperative complications or FEV1 at 1-year post-LTx. Exploratory subgroup analysis revealed an association between psoas sarcopenia and 1-yer all-cause mortality in patients with ILD (multivariable p = 0.042). CONCLUSIONS: Pre-established sex-specific cutoffs for psoas sarcopenia did not reach statistical significance for 1-year mortality or perioperative outcomes in the overall cohort; given limited statistical power, a clinically meaningful association cannot be excluded. An exploratory signal in ILD patients warrants further investigation. Future studies may benefit from disease-specific threshold validation and the integration of muscle strength and physical performance alongside muscle mass assessment.