The Impact of Frailty, Sarcopenia, and Malnutrition on Liver Transplant Outcomes

Duong, Nikki; Sadowski, Brett; Rangnekar, Amol S.

doi:10.1002/cld.1043

Cited by 14 publications

(14 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…21,22 Thus, early assessment and consequent treatment of malnourishment may not only reduce perioperative morbidity and functional deterioration, but could also improve the oncologic risk profile. 23 The PNI is a cost-effective serum-based parameter for immunonutritional evaluation. In recent years, it evolved to a widely accepted biomarker in many cancer entities, including HCC.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Preoperative Prognostic Nutritional Index May Be a Strong Predictor of Hepatocellular Carcinoma Recurrence Following Liver Transplantation

Kornberg¹,

Kaschny²,

Kornberg³

et al. 2022

JHC

View full text Add to dashboard Cite

Malnutrition is a major risk factor of immune dysfunction and poor outcome in cancer patients. The prognostic nutritional index (PNI), which is established by serum albumin level and peripheral lymphocyte count, was shown to correlate with prognosis of hepatocellular carcinoma (HCC) patients following liver resection and non-surgical interventions. The aim of this study was to analyze the predictive value of preoperative PNI in liver transplantation (LT) patients with HCC. Patients and Methods: A total of 123 HCC patients that underwent LT were included in the analysis. The prognostic impact of preoperatively assessed clinical factors including the PNI on post-LT outcome was analyzed by uni-and multivariate analysis. Results: Post-transplant tumor recurrence rates were 5.1% in high-PNI (> 42) and 55.6% in low-PNI (≤ 42) patients (p < 0.001). Preoperative high-PNI could be identified as a significant and independent promoter of both recurrence-free survival (hazard ratio [HR] = 10.12, 95% CI: 3.40-30.10; p < 0.001) and overall survival (HR = 1.69, 95% CI: 1.02-2.79; p = 0.004) following LT. Apart from that low-PNI proved to be a significant and independent predictor of microvascular tumor invasion (OR = 7.71, 95% CI: 3.17-18.76; p < 0.001). In contrast, no tumor morphology features including the Milan criteria revealed an independent prognostic value. Conclusion:Our data indicate that preoperative PNI correlates with biological tumor aggressiveness and outcome following LT in HCC patients and may therefore be useful for refining oncologic risk stratification.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Preoperative Prognostic Nutritional Index May Be a Strong Predictor of Hepatocellular Carcinoma Recurrence Following Liver Transplantation

Kornberg¹,

Kaschny²,

Kornberg³

et al. 2022

JHC

View full text Add to dashboard Cite

show abstract

“…Intervention on modifiable prognostic factors is part of the management of patient candidates for LT to improve their overall outcome. Recent literature has highlighted that sarcopenia is a common feature of adult patients with CLD, with a significant negative impact on both LT waitlist mortality and outcomes ( 22 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia in children with chronic liver disease: Prevalence and impact on liver transplant outcomes

Veraldi

Pietrobattista²,

Soglia³

et al. 2022

Front. Pediatr.

View full text Add to dashboard Cite

Sarcopenia is a clinical condition characterized by a reduction in muscle mass, which typically affects adult patients; however, it has recently been recognized in pediatric literature. Few studies in children with chronic liver disease (CLD) undergoing liver transplantation (LT) have investigated the role of sarcopenia, with controversial results. The aim of our study was to assess the prevalence and impact of sarcopenia among children with CLD who are candidates for LT. We conducted a retrospective, single-center study at Bambino Gesù Children's Hospital (Rome, Italy) from July 2016 to July 2021, evaluating all children (0–16 years old) with CLD listed for LT with an abdomen computed tomography imaging available before LT. The total psoas muscle surface area (t-PMSA) was defined as the sum of left and right psoas muscle surface area measured at L4–L5 on axial images. The t-PMSA z-score was calculated according to reference data, and sarcopenia was defined as a t-PMSA z-score of ≤−2 (1–16 years) or a psoas muscle index [PMI; PMI = t-PMSA/(100 × BSA)] of <50th percentile of the population examined (<1 year). Clinical, laboratory, and LT outcome data were collected from all the patients with CLD. 27 out 48 (56%) of the patients aged 1–16 years were sarcopenic. No differences were noted in anthropometrics, nutritional support, liver function tests, model for ESLD (MELD), or pediatric ESLD (PELD) scores between patients with and without sarcopenia. The former showed a higher prevalence of respiratory complications (66.7% vs. 42.1%) and need for inotropes (40.7% vs. 10.8%) after LT. Among patients aged 0–1 years (n: 36), those with reduced muscle mass (50%) had a longer hospitalization time (44 vs. 24 days) and higher incidences of multi-organ failure syndrome (38.9% vs. 0%) and intensive care unit-related infections (61.1% vs. 27.8%) compared to those with greater muscle mass. t-PMSA and PMI were statistically significant predictors of LT outcomes. Sarcopenia is a reliable index of frailty in children with CLD, as its presence is associated with the risk of a more challenging LT. Future studies will have to investigate the functional aspects of sarcopenia and conceive preventive measures of muscle wasting in CLD patients.

show abstract

“…Additionally, sarcopenia portends increased risk for complications and poor clinical outcomes in cirrhotic patient, specifically hepatic encephalopathy, sepsis, and overall mortality; it is also associated with worse outcomes after liver transplantation, including increased ICU length of stay, dependence on mechanical ventilation, organ injury, and post-operative mortality [61,62] . Additionally, sarcopenia itself is a significant independent risk factor for NAFLD/NASH and fibrosis, which can exacerbate liver disease and accelerate progression to or worsening of cirrhosis [63] .…”

Section: Sarcopenia Cirrhosis and Impact On Outcomesmentioning

confidence: 99%

Sarcopenia in the Cirrhotic Patient: Current Knowledge and Future Directions

Warner

2023

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

The Impact of Frailty, Sarcopenia, and Malnutrition on Liver Transplant Outcomes

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/17-4-reading-duong a video presentation of this article

Cited by 14 publications

References 27 publications

Preoperative Prognostic Nutritional Index May Be a Strong Predictor of Hepatocellular Carcinoma Recurrence Following Liver Transplantation

Preoperative Prognostic Nutritional Index May Be a Strong Predictor of Hepatocellular Carcinoma Recurrence Following Liver Transplantation

Sarcopenia in children with chronic liver disease: Prevalence and impact on liver transplant outcomes

Sarcopenia in the Cirrhotic Patient: Current Knowledge and Future Directions

Contact Info

Product

Resources

About