Impact of Sarcopenic Obesity on Outcomes after Liver Transplantation; Does Sarcopenic Obesity cause Poor Prognosis?

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IntroductionWe have reported that sarcopenia is a poor prognostic factor after liver transplantation (LT). However, the significance of sarcopenic obesity is unclear. In this study, we examined the impact of sarcopenic obesity on outcomes after living donor LT (LDLT).MethodsWe retrospectively analyzed 277 adult patients who underwent LDLT at our institute between January 2008 and June 2016. Using preoperative plain computed tomography imaging at the third lumbar vertebra level, skeletal muscle mass, muscle quality, and visceral adiposity were evaluated by the skeletal muscle mass index (SMI), intramuscular adipose tissue content (IMAC), and visceral to subcutaneous adipose tissue area ratio (VSR), respectively. In this study, we defined low skeletal muscle mass (SMI: male <40.31cm2/m2, female <30.88cm2/m2) and visceral fat area >=100cm2 as sarcopenic obesity. Using this definition, we divided all patients into 4 groups, non-sarcopenic/non-obesity (NN), non-sarcopenic/obesity (NO), sarcopenic/non-obesity (SN), and sarcopenic/obestiy (SO) groups. Overall survivals after LT liver transplantation were compared among the 4 groups Independent risk factors after LT were also analyzed.ResultsOne/five-y OS in patients with of NN group (n=167) were 86%/80%. Compared with NN group, 1/5-y OS in patients of NO (n=55), SN (n=46), and SO (n=9) was 84%/75% (P=0.505), 59%/46% (P<0.001), and 56%/56% (P=0.056), respectively. Multivariate analysis identified low SMI (P=0.020), high IMAC (muscle steatosis) (P<0.001), high VSR (visceral adiposity) (P=0.001), and post-transplant bacteremia (P<0.001) as independent risk factores for death after LT.ConclusionPatients with sarcopenic obesity had worse survival after LDLT. Low muscle mass, muscle steatosis, and visceral adiposity were independent risk factors after LDLT.

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