Effect of Preoperative Sarcopenia, Malnutrition and Functional status on Postoperative Morbidity Following Liver Transplantation

Abstract

Introduction The effect of sarcopenia, malnutrition, and functional status on immediate post liver transplantation outcome is not well established. Most studies on sarcopenia are related to 1 and 3-year mortality. Studies evaluating the effect of malnutrition are at least a decade old. Project Aims We evaluated the effect of preoperative sarcopenia, malnutrition, and functional status on postoperative length of hospital and ICU stay, incidence of complications, and mortality. Design In this prospective study conducted on living donor liver transplant recipients, sarcopenia and malnutrition were identified using the psoas muscle thickness to height and the Royal Free Hospital- Nutritional Prioritizing Tool respectively. The Eastern Cooperative Oncology Group performance status score was noted. Postoperatively, length-of-hospital stay, ICU stay, duration of mechanical ventilation and incidence of postoperative complications were noted. Results Hospital and ICU length of stay, and duration of mechanical ventilation were greater in sarcopenic versus non-sarcopenic patients (35.9 (14.6) versus 26.7 (10.7) days, P = 0.02; 12.9 (4.8) versus 9.6 (3.8) days, P = 0.02 and 8 [5,23] versus 5 [4,7] days, P = 0.01 respectively). The incidence of acute kidney injury was higher in patients with sarcopenia (53.3% vs 19.4%, P = 0.02). Patients with malnutrition and repeated hospitalizations had higher ICU stays but hospital length of stay duration of mechanical ventilation or the incidence of postoperative complications were not affected. The Eastern Cooperative Oncology Group score did not affect postoperative outcome. Conclusion In living donor liver transplant recipients, sarcopenia increased hospital and ICU stays, and duration of mechanical ventilation postoperatively. Malnutrition increased ICU stays.

Predictors for pathological bone fractures in children undergoing liver transplantation: A retrospective cohort study

“…Children with PF were significantly more under nutritional support than those without PF. This validates our strong effort to improve the child's nutritional status, avoid malnutrition and counter‐act hepatic osteodystrophy, knowing that LT outcomes are better in the context of good nutritional condition 14–16 . The link between the nutritional condition and bone health has been reported by Kotb et al.…”

“…This validates our strong effort to improve the child's nutritional status, avoid malnutrition and counter-act hepatic osteodystrophy, knowing that LT outcomes are better in the context of good nutritional condition. [14][15][16] The link between the nutritional condition and bone health has been reported by patients with an abnormal dual X-ray scan also had lower weight z-scores before LT. This work underlines moreover that patients who sustain PF have significantly higher levels of total and conjugated bilirubin at the moment of LT, suggesting that cholestatic patients are more prone to have PF.…”

Sarcopenia is an independent risk factor for short-term mortality in patients undergoing transjugular intrahepatic portosystemic shunt

“…Our retrospective, single-center study indicates that the presence of sarcopenia in cirrhotic patients is a strong and independent risk factor for short-term mortality after TIPS placement. We were able to present a PMI cutoff value of 4.4 cm 2 /m 2 for males and 3.2 cm 2 /m 2 for females in defining sarcopenia and our results demonstrate that sarcopenia by this definition is associated with an increased risk of short-term 1-year mortality (hazard A growing body of literature supports the association between sarcopenia and mortality in various types of malignancies [19] and liver or renal transplantation [20]. A study on 200 patients undergoing living donor liver transplantation reported that patients with high intramuscular adipose tissue content and low PMI had lower overall survival rates compared to those with normal values [21].…”

“…A growing body of literature supports the association between sarcopenia and mortality in various types of malignancies [19] and liver or renal transplantation [20]. A study on 200 patients undergoing living donor liver transplantation reported that patients with high intramuscular adipose tissue content and low PMI had lower overall survival rates compared to those with normal values [21].…”