Impact of Sarcopenia on the Outcomes After Living-Donor Liver Transplantation

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Abstract

Background

Sarcopenia is reported as an adverse prognostic factor in various diseases. We investigated whether the preoperative sarcopenia status has some impacts on the postoperative outcomes after adult living-donor liver transplantation (LDLT).

Material/Methods

Adult recipients who underwent LDLT in our department between 2005 and 2017 (n=100) were subjected to this study. The recipients were divided into the sarcopenia and non-sarcopenia groups (S and N groups, respectively) based on the skeletal muscle index (SMI, skeletal mass area at the third lumbar vertebrae (L3) level (cm2) / height2 (m2)). SMI was measured on the preoperative plain CT images using an analyzer SYNAPSE VINCENT (Fujifilm, Tokyo, Japan). We defined sarcopenia as a skeletal muscle index (SMI)< 42 cm2/m2 (male) and < 38 cm2/m2 (female) according to criteria for determination of sarcopenia in liver diseases established by the Japan Society of Hepatology. The recipients in S and N groups were further divided into subgroups depending on the ABO blood-type compatibility. We compared clinical parameters between the groups or subgroups. We performed multivariate analyses to identify predictive factors for infection, rejection and survival.

Results

The incidence of bacterial infection was significantly higher in the S group (n=47) compared to N group (n=53). The incidence of rejection (acute cellular rejection and antibody mediated rejection) was significantly lower in the S group compared to the N group. A statistically significant difference was also detected in the comparison of incidence of rejection between the non-ABO incompatible in S and N groups. There was no significant difference in rate of discharge from hospital between the groups. The 3- and 5- year overall survival rates were 82.1 % and 82.1 % in the S group, and 76.6 % and 73.2 % in the N group, respectively. There was no significant difference in overall survival between the S and N groups. A multivariate analysis indicated that sarcopenia was significant predictive factor for bacterial infection and rejection. In the multivariate analysis for survival, biliary reconstruction (hepaticojejunostomy), older donor (≥40 years), small graft size (GRWR<0.8) and performing EEN were significant prognostic factors for post-transplant survival, but sarcopenia was not a significant prognostic factor.

Conclusions

Although sarcopenia recipients had equivalent overall survival rate to non-sarcopenia recipients under the current postoperative management, sarcopenia had an impact on the postoperative incidences of bacterial infection and rejection.

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