Perioperative loss of psoas muscle is associated with patient survival in living donor liver transplantation

Abstract

Patients with end-stage liver disease show sarcopenia, and preoperative sarcopenia is independently associated with patient mortality after liver transplantation. However, few studies have examined the relationship between perioperative loss of core muscle and patient mortality in living donor liver transplantation (LDLT). This study was performed to investigate the association between a perioperative decrease in the psoas muscle index (PMI) and patient mortality after LDLT. Adult patients (age ≥ 18 years) undergoing LDLT between January 2009 and December 2016 were classified into low-loss (>25th quartile) versus high-loss (≤25th quartile) groups according to PMI change between the day before surgery and postoperative day (POD) 7. Patient survival was compared between the 2 groups, and factors affecting survival were analyzed. The median (interquartile range) level of PMI change from the day before surgery to POD 7 was -4.8% (-11.7%-1.2%). Although there was no preoperative difference in PMI between the low-loss and high-loss groups, patients with PMI change ≤-11.7% showed poorer survival than those with PMI change >-11.7% during the follow-up period. A PMI decrease ≤-11.7% between the day before surgery and POD 7 is an independent predictor of patient mortality after LDLT. In addition, intraoperative packed red blood cell transfusion, graft fat percentage, and reoperation and infection after surgery were significantly associated with patient mortality. In conclusion, a PMI decrease ≤-11.7% between the day before surgery and POD 7 is an independent predictor of patient mortality after LDLT. It is necessary to identify the factors responsible for the perioperative decrease in skeletal muscle mass and to ascertain if they are modifiable to improve patient survival after LDLT. Liver Transplantation 24 623-633 2018 AASLD.

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 …”

“…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.…”

“…The sample size ranged from 40 to 795 patients who were aged between 50 and 61 years. The MELD score ranged from 14 to 22, with hepatocellular carcinoma (HCC), hepatitis C virus (HCV), and alcoholic liver disease being the top 3 indications for LT. For the majority of the studies (n = 10/13), acute and cryptogenic liver disease accounted for ≤7% of the underlying liver disease type (Table ) . The time between body composition measurement and LT varied from 7 to 200 days.…”

“…CT was the most commonly used body composition method (n = 30/35), followed by BIA (n = 3/35) and concurrent use of CT and MRI (n = 2/35) . In studies that used an imaging modality (n = 32/35), there were inconsistencies in lumbar vertebrate measurement level (62% at L3, 16% at L4, 16% at L3/L4, and 6% at umbilical level [UL]). A total of 16/32 studies used total skeletal muscle area (SMA) to define sarcopenia, whereas 44% (n = 14/32) based their assessment on a single psoas muscle area (PMA) .…”

Muscle mania: The enduring importance of muscle mass in liver disease

“…In this issue of Liver Transplantation , Chae et al provide the first description of changes in muscle mass during the perioperative period of living donor LT and how these changes affect posttransplant outcomes . Chae et al are to be commended for systematically assessing perioperative muscle changes in 408 of the 473 living donor LT recipients at their institution over 7 years, using protocol computed tomography (CT) imaging on postoperative days (PODs) 7 and 21, and at 6 and 12 months after LT.…”