Skeletal muscle depletion, referred to as sarcopenia, predicts morbidity and mortality in patients undergoing digestive surgery. However, the impact on liver transplantation is unclear. The present study investigated the impact of sarcopenia on patients undergoing living donor liver transplantation (LDLT). Sarcopenia was assessed by a body composition analyzer in 124 adult patients undergoing LDLT between February 2008 and April 2012. The correlation of sarcopenia with other patient factors and the impact of sarcopenia on survival after LDLT were analyzed. The median ratio of preoperative skeletal muscle mass was 92% (range, 67-130%) of the standard mass. Preoperative skeletal muscle mass was significantly correlated with the branched-chain amino acids to tyrosine ratio (r ¼ À0.254, p ¼ 0.005) and body cell mass (r ¼ 0.636, p < 0.001). The overall survival rate in patients with low skeletal muscle mass was significantly lower than in patients with normal/high skeletal muscle mass (p < 0.001). Perioperative nutritional therapy significantly increased overall survival in patients with low skeletal muscle mass (p ¼ 0.009). Multivariate analysis showed that low skeletal muscle mass was an independent risk factor for death after transplantation. In conclusion, sarcopenia was closely involved with posttransplant mortality in patients undergoing LDLT. Perioperative nutritional therapy significantly improved overall survival in patients with sarcopenia.

Electron diffusion coefficient, lifetime, and density in the TiO(2) electrode of dye-sensitized TiO(2) solar cells (DSCs) employing I(-)/I(3)(-) redox couples were measured with eight different metal-free organic dyes and three Ru complex dyes. At matched electron density, all DSCs using organic dyes (ODSCs) showed shorter electron lifetime with comparable or larger diffusion coefficients in comparison to the DSCs using the Ru dyes (RuDSC). The shorter lifetime was attributed partially to the slower dye cation reduction rate of the organic dyes by I(-), faster electron diffusion coefficient in the TiO(2), and mostly higher I(3)(-) concentration in the vicinity of the TiO(2) surface. Whereas a slight shift of the conduction band edge potential (E(cb)) of the TiO(2) was seen with a few organic dyes, no correlation was found with the dipole moment of the adsorbed dyes. This implies that the adsorbed dyes interact with cations in the electrolyte, so the direction of the dipole is altered or simply screened. The increase of [I(3)(-)] in the vicinity of the TiO(2) surface was interpreted with partial charge distribution of the dyes. Under one-sun conditions, less electron density due to shorter electron lifetime was found to be the main reason for the lower values of V(oc) for all ODSCs in comparison to that of RuDSCs. Among the organic dyes, having larger molecular size and alkyl chains showed longer electron lifetime, and thus higher V(oc). Toward higher open circuit voltage, a design guide of organic dyes controlling the electron lifetime is discussed.

To prevent small-for-size syndrome in adult-to-adult living donor liver transplantation (A-LDLT), larger grafts (ie, right lobe grafts) have been selected in many transplant centers. However, some centers are investigating the benefits of portal pressure modulation. Five hundred sixty-six A-LDLT procedures using right or left lobe grafts were performed between 1998 and 2008. In 2006, we introduced intentional portal pressure control, and we changed the graft selection criteria to include a graft/recipient weight ratio >0.7% instead of the original value of >0.8%. All recipients were divided into period I (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006), the era of unintentional portal pressure control; n ¼ 432) and period II (2006II ( -2008, the era of intentional portal pressure control; n ¼ 134). The selection of small-for-size grafts increased from 7.8% to 23.9%, and the selection of left lobe grafts increased from 4.9% to 32.1%. Despite the increase in the number of smaller grafts in period II, 1-year patient survival was significantly improved (87.9% versus 76.2%). In 129 recipients in period II, portal pressure was monitored. Patients with a portal pressure <15 mm Hg demonstrated better 2-year survival (n ¼ 86, 93.0%) than patients with a portal pressure !15 mm Hg (n ¼ 43, 66.3%). The recovery from hyperbilirubinemia and coagulopathy after transplantation was significantly better in patients with a portal pressure <15 mm Hg. In conclusion, our strategy for A-LDLT has changed from larger graft-based A-LDLT to controlled portal pressure-based A-LDLT with smaller grafts. A portal pressure <15 mm Hg seems to be a key for successful A-LDLT. Liver Transpl 16:718-728,

Intramuscular fat accumulation has come to be associated with loss of muscle strength and function, one of the components of sarcopenia. However, the impact of preoperative quality of skeletal muscle on outcomes after living donor liver transplantation (LDLT) is unclear. The present study evaluated the intramuscular adipose tissue content (IMAC) and psoas muscle mass index (PMI) in 200 adult patients undergoing LDLT at our institution between January 2008 and October 2013. Correlations of IMAC with other factors, overall survival rates in patients classified according to IMAC or PMI, and risk factors for poor survival after LDLT were analyzed. IMAC was significantly correlated with age (r 5 0.229, P 5 0.03) and PMI (r 5 20.236, P 5 0.02) in males and with age (r 5 0.349, P < 0.001) and branched-chain amino acid (BCAA)-to-tyrosine ratio (r 5 20.250, P 5 0.01) in females. The overall survival rates in patients with high IMAC or low PMI were significantly lower than those for patients with normal IMAC or PMI (P < 0.001, P < 0.001, respectively). Multivariate analysis showed that high IMAC [odds ratio (OR) 5 3.898, 95% confidence interval (CI) 5 2.025-7.757, P < 0.001] and low PMI (OR 5 3.635, 95% CI 5 1.896-7.174, P < 0.001) were independent risk factors for death after LDLT. In conclusion, high IMAC and low PMI were closely involved with posttransplant mortality. Preoperative quality and quantity of skeletal muscle could be incorporated into new selection criteria for LDLT. Perioperative nutritional therapy and rehabilitation could be important for good outcomes after LDLT. See Editorial on Page 1293Sarcopenia is defined as a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, with a risk of adverse outcomes such as physical disability, poor quality of life, and death. 1 Recent evidence has shown that sarcopenia is an independent predictor of lower disease-free and overall survival in various kinds of diseases. [2][3][4] In patients with liver cirrhosis (LC), protein malnutrition, which is caused by decreased protein synthesis and disturbed energy metabolism, can cause a decrease in skeletal muscle mass. In recent studies, sarcopenia was found to be present in approximately one-third of patients with hepatocellular carcinoma (HCC) and LC who were being evaluated for liver transplantation (LT), and sarcopenia was found to be an independent prognostic factor for overall and recurrence-

For the identification of susceptibility loci for primary biliary cirrhosis (PBC), a genome-wide association study (GWAS) was performed in 963 Japanese individuals (487 PBC cases and 476 healthy controls) and in a subsequent replication study that included 1,402 other Japanese individuals (787 cases and 615 controls). In addition to the most significant susceptibility region, human leukocyte antigen (HLA), we identified two significant susceptibility loci, TNFSF15 (rs4979462) and POU2AF1 (rs4938534) (combined odds ratio [OR] = 1.56, p = 2.84 × 10(-14) for rs4979462, and combined OR = 1.39, p = 2.38 × 10(-8) for rs4938534). Among 21 non-HLA susceptibility loci for PBC identified in GWASs of individuals of European descent, three loci (IL7R, IKZF3, and CD80) showed significant associations (combined p = 3.66 × 10(-8), 3.66 × 10(-9), and 3.04 × 10(-9), respectively) and STAT4 and NFKB1 loci showed suggestive association with PBC (combined p = 1.11 × 10(-6) and 1.42 × 10(-7), respectively) in the Japanese population. These observations indicated the existence of ethnic differences in genetic susceptibility loci to PBC and the importance of TNF signaling and B cell differentiation for the development of PBC in individuals of European descent and Japanese individuals.

Preoperative sarcopenia, indicating low quality and quantity of skeletal muscle, is closely related to mortality after resection of pancreatic cancer.

Metabolic network rewiring is the rerouting of metabolism through the use of alternate enzymes to adjust pathway flux and accomplish specific anabolic or catabolic objectives. Here, we report the first characterization of two parallel pathways for the breakdown of the short chain fatty acid propionate in Caenorhabditis elegans. Using genetic interaction mapping, gene co-expression analysis, pathway intermediate quantification and carbon tracing, we uncover a vitamin B12-independent propionate breakdown shunt that is transcriptionally activated on vitamin B12 deficient diets, or under genetic conditions mimicking the human diseases propionic- and methylmalonic acidemia, in which the canonical B12-dependent propionate breakdown pathway is blocked. Our study presents the first example of transcriptional vitamin-directed metabolic network rewiring to promote survival under vitamin deficiency. The ability to reroute propionate breakdown according to B12 availability may provide C. elegans with metabolic plasticity and thus a selective advantage on different diets in the wild.DOI: http://dx.doi.org/10.7554/eLife.17670.001

We evaluated the effects of rituximab prophylaxis on outcomes of ABO‐blood‐type‐incompatible living donor liver transplantation (ABO‐I LDLT) in 381 adult patients in the Japanese registry of ABO‐I LDLT. Patients underwent dual or triple immunosuppression with or without B cell desensitization therapies such as plasmapheresis, splenectomy, local infusion, intravenous immunoglobulin and rituximab. Era before 2005, intensive care unit‐bound status, high Model for End‐Stage Liver Disease score and absence of rituximab prophylaxis were significant risk factors for overall survival and antibody‐mediated rejection (AMR) in the univariate analysis. After adjustment for era effects in the multivariate analysis, only absence of rituximab prophylaxis was a significant risk factor for AMR, and there were no significant risk factors for survival. Rituximab prophylaxis significantly decreased the incidence of AMR, especially hepatic necrosis (p < 0.001). In the rituximab group, other B cell desensitization therapies had no add‐on effects. Multiple or large rituximab doses significantly increased the incidence of infection, and early administration had no advantage. In conclusion, outcomes in adult ABO‐I LDLT have significantly improved in the latest era coincident with the introduction of rituximab.