Newly Developed Sarcopenia as a Prognostic Factor for Survival in Patients who Underwent Liver Transplantation

Abstract

IntroductionThe relationship between a perioperative change in sarcopenic status and clinical outcome of liver transplantation (LT) is unknown. We investigated whether post-LT sarcopenia and changes in sarcopenic status were associated with the survival of patients.MethodThis retrospective study was based on a cohort of 145 patients from a single transplant center who during a mean of 1 year after LT underwent computed tomography imaging evaluation. The cross-sectional area of the psoas muscle of LT patients was compared with that of age- and sex-matched healthy individuals. The Cox proportional hazards regression model was used to determine whether post-LT sarcopenia and changes in sarcopenic status affect post-LT survival.ResultsThe mean age at LT of the 116 male and 29 female patients was 50.2 ± 7.9 years; the mean follow-up duration was 51.6 ± 32.9 months. All pre-LT patients with sarcopenia still had sarcopenia 1 year after LT; 14 (15%) patients had newly developed sarcopenia. The mean survival duration was 91.8 ± 4.2 months for non-sarcopenic patients and 80.0 ± 5.2 months for sarcopenic patients (log-rank test, p = 0.069). In subgroup analysis, newly developed sarcopenia was an independent negative predictor for post-LT survival (hazard ratio: 10.53, 95% confidence interval: 1.37–80.93, p = 0.024).ConclusionSarcopenia in LT recipients did not improve in any of the previously sarcopenic patients and newly developed within 1 year in others. Newly developed sarcopenia was associated with increased mortality. Newly developed sarcopenia can be used to stratify patients with regard to the risk of post-LT mortality.

Sarcopenia in Chronic Liver Disease: Impact on Outcomes

“…. A total of 38 articles (years 2010‐2018) were included, in which 92% (n = 35) were conducted in adults and 8% (n = 3) were conducted in pediatric populations …”

“…The majority of studies (n = 29/35) focused on pre‐LT sarcopenia, which included studies that characterized patients with sarcopenia (n = 26), SO (n = 1) as well as both sarcopenia and SO (n = 2) . Five studies longitudinally tracked changes in pre‐LT sarcopenia into the post‐LT period (up to 19.3 months) . Only 1 article evaluated post‐LT SO .…”

“…Only 1 article evaluated post‐LT SO . Most of the studies were performed retrospectively (n = 30/35) . The sample size ranged from 40 to 795 patients who were aged between 50 and 61 years.…”

Sarcopenia in liver transplant recipients: its relevance to peritransplant morbidity and mortality

“…Moreover, 15% who were preoperatively non-sarcopenic developed sarcopenia after liver transplantation (5). Several reports also suggested that muscle depletion has not recovered in the first year after liver transplant (14).…”

“…The state of sarcopenia rather worsen after liver transplantation. Jeon et al (5) reported that sarcopenia continued to be a risk factor for mortality even in patients who managed to survive their early posttransplant periods. Because sarcopenia continues, or rather worsens in some recipients, after liver transplantation, their vulnerability to infections, frailty syndrome in general, caused by sarcopenia should be seriously cautioned in addition to the problems relating to immunosuppressants.…”