The combination of a male donor’s high muscle mass and quality is an independent protective factor for graft loss after living donor liver transplantation

Abstract

Several studies have demonstrated that higher donor age is a strong risk factor for poor graft function or survival after both deceased-donor 1 and living-donor liver transplantation (DDLT and LDLT, respectively). 2,3 This seems to be natural because the liver is an organ strongly affected by aging. 4 However, age itself is a multifactorial phenomenon and, although the vigorous efforts in basic science are now unraveling the mechanism of liver senescence, 4 some ambiguities remain about how aging is associated with impaired liver function and regenerative capacity after liver transplantation. 5,6 Therefore, we suspect that there may be

Does donor muscularity “pump up” living donor liver transplant survival?

“…In conclusion, this interesting report showed—for the first time—that donor physical/functional status can affect LDLT outcomes 2 . This report raises the question of how transplant surgeons should prepare donors for donation.…”

“…In this issue of the American Journal of Transplantation, Miyachi et al report the impact of male living donor muscle mass and quality on the outcome of 198 LDLTs. 2 Using a previously published method to calculate muscularity, 3 liver grafts from "high muscularity donors" (n = 38) (ie, those with higher skeletal muscle mass index [SMI] and lower intramuscular adipose tissue content [IMAC]) showed better 1-year (97% vs 82%; P = .020) and overall graft survival rate (88% vs 67%, P = .024) compared with controls (n = 160). In contrast, female donor muscularity did not proffer the same protective effect as seen in male donor cases.…”

“…In conclusion, this interesting report showed-for the first time-that donor physical/functional status can affect LDLT outcomes. 2…”

Reply to: Effects of donor muscle and sex on graft function in living-donor liver transplantation

“…We are grateful to Gocho et al 1 for commenting on our recent publication describing the impact of living donors' muscularity on graft survival after living donor liver transplantation (LDLT). 2 We read the letter with great interest. Their questions are very important to clarify the essential point of our study.…”

Effects of donor muscle and sex on graft function in living-donor liver transplantation

“…The authors used age-adjusted values, not definite values, for SMI and IMAC. 1 In the correlation plots for donor SMI and IMAC with age, the slope of the adjusted linear line for IMAC became steeper with age. For example, a 50-year-old male donor with an IMAC of −0.50 was regarded as having "high muscularity," although a 20-year-old male donor with the same IMAC of −0.50 should be regarded as having "low muscularity."…”