Proposal for new selection criteria considering pre‐transplant muscularity and visceral adiposity in living donor liver transplantation

Abstract

BackgroundThe significance of pre‐operative body composition has recently attracted much attention in various diseases. However, cut‐off values for these parameters remain undetermined, and these factors are not currently included in selection criteria for recipients of living donor liver transplantation (LDLT).MethodsUsing computed tomography of 657 donors for LDLT, skeletal muscle mass, muscle quality, and visceral adiposity were evaluated by using skeletal muscle mass index (SMI), intramuscular adipose tissue content (IMAC), and visceral‐to‐subcutaneous adipose tissue area ratio (VSR). Sex‐specific cut‐offs for SMI, IMAC, and VSR were determined, and correlations with outcomes after LDLT in 277 recipients were examined with the aim of establishing new selection criteria for LDLT.ResultsOn the basis of younger donor data, we determined sex‐specific cut‐off values for low SMI, high IMAC, and high VSR (mean ± 2 standard deviations). Patients with all three factors showed the lowest survival rate after LDLT (1 year survival rate, 41.2%; P < 0.001). On multivariate analysis, low SMI (P = 0.002), high IMAC (P = 0.002), and high VSR (P = 0.001) were identified as independent risk factors for mortality after LDLT. Based on these findings, we have excluded patients showing all three factors (low SMI, high IMAC, and high VSR) as candidates for LDLT since October 2016.ConclusionsUsing cut‐off values determined from healthy donors, we have established new selection criteria for LDLT including body composition, which should improve post‐transplant outcomes.

Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation

“…2,16,20 While some studies have suggested a potential role of myosteatosis in OLT, all of these reports were focusing predominantly on sarcopenia and/or living donor liver transplantation. 2,15,22,35,36 The specific effect of myosteatosis on the perioperative outcomes of deceased donor OLT remains to be determined. In our cohort, patients with myosteatosis had significantly more major complications over the first 3 months and low muscle density was additionally associated with increased rates of EAD, higher CCI scores, and an increased need for intraoperative blood transfusions.…”

“…In myosteatosis, an increasing intramuscular fat accumulation (Figure 1) is associated with a pro-inflammatory microenvironment that potentially impairs immune function via proinflammatory cytokines and adipocytokines. 35,36 These humoral factors and muscle-to-liver cross-talk, together with the limited functional reserves in myosteatotic patients (eg, reduced KPS score, greater need for intraoperative transfusions) may contribute to an increased oxidative stress and graft injury with a higher incidence of EAD during the perioperative phase. 19,37,38 The association of myosteatosis with the abovementioned parameters of perioperative outcome is further supported by the correlation and quartile analyses, demonstrating that gradually decreasing muscle density leads to more perioperative complications, longer in-hospital stay, and higher estimated costs.…”

Assessment of Malnutrition, Sarcopenia and Frailty in Patients with Cirrhosis: Which Tools Should We Use in Clinical Practice?

“…Interestingly, intramuscular fat deposition known as myo-steatosis had a higher prevalence than skeletal muscle loss and was significantly associated with muscle loss [51]. A recent work highlighted the predictive value of myo-steatosis assessed on CT scan for mortality in patients with HCC [52]. In another Japanese cohort, high Intra Muscular Adipose Content (IMAC), low SMI and high visceral to subcutaneous adipose tissue area ratio were independently associated with lower survival [52].…”

“…A recent work highlighted the predictive value of myo-steatosis assessed on CT scan for mortality in patients with HCC [52]. In another Japanese cohort, high Intra Muscular Adipose Content (IMAC), low SMI and high visceral to subcutaneous adipose tissue area ratio were independently associated with lower survival [52]. Assessment of muscle quality is therefore a promising tool in liver diseases (Table 2).…”

Impact of CT-Determined Sarcopenia and Body Composition on Survival Outcome in Patients with Advanced-Stage High-Grade Serous Ovarian Carcinoma

“…To date, the sex-specific cut-off values of SMI for sarcopenia have not been validated in Korean healthy individuals. Adoption of the cut-off values suggested by Japanese study groups was deterred because they were developed in different study populations (e.g., patients with liver disease, [38]) or had age limitations (e.g., <50 years, [39]). In addition, proportions of populations with overweight-obesity are even different between Korea and Japan according to the OECD Health Statistics 2019 [13].…”