Erector spinae muscle radiographic density is associated with survival after lung transplantation

ABSTRACT Objective To verify whether low preoperative radiographic density of erector spinae muscles (ESMs) is associated with poor prognosis after lung transplantation (LTx). Methods Preoperative chest computed tomography (CT) scans for patients who underwent deceased-donor lung transplantation (LTx) between 2013 and 2019 at Kyoto University Hospital were retrospectively retrieved. The radiographic density of ESMs was quantitatively evaluated as the mean attenuation of ESMs (ESMCT), and low ESMCT was defined as an ESMCT value below the median value for all patients. Overall survival (OS) and chronic lung allograft dysfunction-free survival (CFS) with high and low ESMCT were estimated using the Kaplan-Meier method and evaluated by the log-rank test, as well as by univariate and multivariate Cox proportional hazard analyses. Results Of the 107 adult patients who underwent primary transplantation, 96 underwent at least 1 chest CT scan within 24 hours before LTx. The median ESMCT in these 96 patients was 49.2 Hounsfield units. A low ESMCT value was significantly associated with decreased OS (HR, 4.50; p=0.030) and CFS (HR, 3.18; p=0.028) in the multivariate analysis. Additionally, patients with preoperative steroid use and a low ESMCT value had a worse OS (p Conclusion Low ESMCT was closely associated with a poor prognosis after LTx. The prognosis was particularly poor in patients with preoperative steroid use and a low ESMCT. These results may be useful when considering the indications for LTx or preoperative interventions.