Background: The end-stage liver disease causes a metabolic dysfunction whose most prominent clinical feature is the loss of skeletal muscle mass (SMM). In living-donor liver transplantation (LDLT), liver graft regeneration (GR) represents a crucial process to normalize the portal hypertension and to meet the metabolic demand of the recipient. Limited data are available on the correlation between pre-LDLT low SMM and GR.Methods: Retrospective study on a cohort of 106 LDLT patients receiving an extended left liver lobe graft.The skeletal muscle index (SMI) at L3 level was used for muscle mass measurement, and the recommended cut-off values of the Japanese Society of Hepatology guidelines were used as criteria for defining low muscularity. GR was evaluated as rate of volume increase at 1 month post-LT [graft regeneration rate (GRR)]. Results:The median GRR at 1 month post-LT was 91% (IQR, 65-128%) and a significant correlation with graft volume-to-recipient standard liver volume ratio (GV/SLV) (rho −0.467, P<0.001), graft-torecipient weight ratio (GRWR) (rho −0.414, P<0.001), donor age (rho −0.306, P=0.001), 1 month post-LT cholinesterase serum levels (rho 0.397, P=0.002) and pre-LT low muscularity [absent vs. present GRR 97.5% (73.1-130%) vs. 83.5% (45.2-110.9%), P=0.041] was noted. Moreover in male recipients, but not in women, it was shown a direct correlation with pre-LT SMI (rho 0.352, P=0.020) and inverse correlation with 1 month post-LT SMI variation (rho −0.301, P=0.049). A low GRR was identified as an independent prognostic factor for recipient overall survival (HR 6.045, P<0.001).Conclusions: Additionally to the hemodynamic factors of portal circulation and the quality of the graft, the metabolic status of the recipients has a significant role in the GR process. A pre-LT low SMM is associated with impaired GRR and this negative impact is more evident in male recipients.

The aim of the present study was to investigate whether LT candidates with sarcopenia are at an increased risk of receiving an inappropriate standard liver volume (SLV) estimation by standard body weight (BW)-derived SLV formula. Non-BW-SLV estimation formulas were tested in 262 LDLT donors and compared to a standard BW-SLV formula. The anthropometric parameters used were the thoracic width (TW-SLV) and thoracoabdominal circumference (TAC-SLV). Subsequently, sarcopenic and non-sarcopenic LDLT candidates (total, 217 patients) were compared in terms of estimated BW-SLV (routine method) and non-BW-SLV. In donors, TW-SLV showed comparable concordance with CT scan measured total liver volume as BW-SLV. The performance of TAC-SLV was low. In recipients, the prevalence of pre-LT sarcopenia was 30.4%. Sarcopenic patients were attributed a significantly lower BW-SLV than non-sarcopenic (sarcopenia vs no-sarcopenia, 1063.8 ml [1004.1-1118.4] vs. 1220.7 ml [1115.0-1306.6], P < 0.001), despite comparable TW-SLV, age, body height, and gender prevalence. As a result, sarcopenic patients received a graft with a statistically lower weight at organ procurement and developed more frequently a small-for-size syndrome (SFSS) according to the Dahm et al. (27.7% vs. 6.8%, P < 0.01) and Kyushu (28.7% vs. 9.2%, P < 0.01) definition. Therefore, In sarcopenic patients, BW-SLV formulas are affected by an high risk of SLV underestimation, thus exposing them to an increased risk of post-LT SFSS.

General practitioners should consider all the musculoskeletal symptoms when caring for patients with chronic LBP. Rather than systematically screening for specific psychological, social or somatoform disorders, they should consider with the patient how LBP and any type of potential comorbidity interfere with his/her daily functioning.

Background/Aims: The effect of splenectomy on the liver regeneration of a partial graft after living donor liver transplantation (LDLT) is controversial. In recent years, some studies have shown that platelets have strong effects on promoting liver regeneration, but not with a smallfor-size liver graft. This study aimed to validate the effects of splenectomy on liver regeneration rate after LDLT with extended left lobe graft with the middle hepatic vein. Methodology: Of 312 LDLT to date, 32 adult patients at Nagasaki University Hospital (Nagasaki, Japan) transplanted with an extended left lobe graft with middle hepatic vein between April 2013 and April 2019 were retrospectively assessed. In our department, the preoperative platelet count indicated for splenectomy is 50,000/ L. Overall, 13 and 19 patients were included in the splenectomy and without splenectomy groups, respectively. We examined the relations hip between splenectomy and liver volume increase, and postoperative platelet count on the 1st, 3rd, 5th, and 7th postoperative day. The liver volume 1 month (1MVol) after LDLT was estimated using a 3D image analysis system. Results: ROC curve analysis showed the spleen volume threshold for significant volume increase (1MVol/graft weight 2) was 440ml. With regard to 1MVol, no significant difference was observed between the splenectomy and without splenectomy groups. However, in the splenectomy group, recipients with a large spleen (more than 440 ml) led to higher liver volume increase than in those with a small spleen. Platelet count significantly increased from postoperative day 14 in the splenectomy group regardless of the size of the spleen. Conclusions: Simultaneous splenectomy does not always have an effect on liver regeneration in extended left lobe graft LDLT. However, for LDLT recipients with large spleen volume, graft volume increase was affected, probably through vigorous portal venous blood flow but not plateletderived factors.

No abstract