16. Manoela Ferreira

How Ultrasound Can Predict Sarcopenia in Lung Transplant Candidates


  • Stacey Butler says:

    Great work Manoela! What are some of the clinical implications beyond using this tool to screen for sarcopenia? Could the results be used to predict the risk of clinical outcomes?

    • Manoela says:

      Hello Stacey,
      Thank you for your great question.
      The use of the ultrasound for measuring muscle size can increase the number of lung transplant candidates assessed for the presence or not of sarcopenia and this technique is much cheaper than other muscle mass methods, such as D-XA, Bioelectrical impedance, CT or MRI. Also, by using ultrasound we can easily observe muscle size and quality in patients in the ICU or in a ward without having to transported the patient to different rooms. Beyond the accessibility of the ultrasound, by measuring muscle size and sarcopenia in lung transplant candidates we can identify muscle composition and prescribe the right exercise program or dietary supplementation. Additionally, sarcopenia has relationship with Frailty which by itself increase disability. In terms of relationship with clinical outcomes, a study with lung transplant candidates observed that the sarcopenic group had longer ICU and mechanical ventilation length of stay following the transplantation. We see a need for more studies investigating sarcopenia in lung transplant candidates and recipients and clinical outcomes. In our study our next step is to observe the relationship between the sarcopenia cut-points, our ultrasound cut-point and clinical outcomes, such as: waitlist mortality, graft loss, post-transplant mortality, hospital length of stay and physical capacity.

      • Stacey Butler says:

        This is great! Sounds like you have found a great non-invasive & feasible technique that has the potential to improve patient care for this population. Congrats on the excellent work!

  • Adele Coriati says:

    Interesting work Manoela! Does fat mass surrounding these 2 muscles affect severity of sarcopenia and therefore poor outcomes in lung transplant candidates?

    • Manoela Ferreira says:

      Hello Adele,
      Thank you for your great question.
      There is a lack of information between the relationship with midthigh cross-sectional area, fat-free mass and clinical implications in lung transplant patients. Moreover, how occurs the recovery of muscle mass and strength in lung recipients is unclear. Looks like fat mass tissue affect the measurement of muscle quality using the grey scale per example, but how it affects the severity of sarcopenia stills unclear. Furthermore, in solid organ transplant in general, low muscle mass and sarcopenia obesity is associated with greater hospital length of stay, waitlist mortality and post-transplant survival.

  • Kenneth Wu says:

    This is a very interesting study Manoela. I’m just curious if the regression models make any adjustment to patient’s body stature, e.g. BMI, height, leg length, etc. Would body stature affects the cut-points to predict sarcopenia?

    • Manoela Ferreira says:

      Good morning Kenneth,
      Thank you for your great question.
      Yes, we normalized the ultrasound analysis by the leg length in centimeters and the ALMI is normalized by the height2. So, we do not include BMI or height in the regression model, once it was included under the normalization. This way, following our proposal, after measuring muscle size is necessary to normalize the result by the leg length, because the leg length may affect the cut-point to predict sarcopenia.

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