Impact of sarcopenia on mortality in patients undergoing liver re-transplantation

Abstract

BACKGROUND Sarcopenia, which is a loss of skeletal muscle mass, has been reported to increase post-transplant mortality and morbidity in patients undergoing the first liver transplant. Cross-sectional imaging modalities typically determine sarcopenia in patients with cirrhosis by measuring core abdominal musculatures. However, there is limited evidence for sarcopenia related outcomes in patients undergoing liver re-transplantation (re-OLT). AIM To evaluate the risk of mortality in patients with pre-existing sarcopenia following liver re-OLT. METHODS This is a retrospective study of all adult patients who had undergone a liver re-OLT at the University of Nebraska Medical Center from January 1, 2007 to January 1, 2017. We divided patients into sarcopenia and no sarcopenia groups. “TeraRecon AquariusNet 4.4.12.194” software was used to evaluate computed tomography or magnetic resonance imaging of the patients done within one year prior to their re-OLT, to calculate the Psoas muscle area at L3-L4 intervertebral disc. We defined cutoffs for sarcopenia as < 1561 mm 2 for males and < 1464 mm 2 for females. The primary outcome was to compare 90 d, one, and 5-year survival rates. We also compared complications after re-OLT, length of stay, and re-admission within 30 d. Survival analysis was performed with Kaplan-Meier survival analysis. Continuous variables were evaluated with Wilcoxon rank-sum tests. Categorical variables were evaluated with Fisher’s exact tests. RESULTS Fifty-seven patients were included, 32 males: 25 females, median age 50 years. Two patients were excluded due to incomplete information. Overall, 47% (26) of patients who underwent re-OLT had sarcopenia. Females were found to have significantly more sarcopenia than males (73% vs 17%, P < 0.001). Median model for end stage liver disease at re-OLT was 28 in both sarcopenia and no sarcopenia groups. Patients in the no sarcopenia group had a trend of longer median time between the first and second transplant (36.5 mo vs 16.7 mo). Biological markers, outcome parameters, and survival at 90 d, 1 and 5 years, were similar between the two groups. Sarcopenia in re-OLT at our center was noted to be twice as common (47%) as historically reported in patients undergoing primary liver transplantation. CONCLUSION Overall survival and outcome parameters were no different in those with and without the evidence of sarcopenia after re-OLT.

Radiological assessment of skeletal muscle index and myosteatosis and their impact postoperative outcomes after liver transplantation

“…9 Lower muscle mass is also associated with a higher incidence of hepatic encephalopathy in patients with end-stage liver disease. 38,39 On the other hand, a group from USA 40 showed that sarcopenic patients had a higher tendency for pulmonary complications than the nonsarcopenic group (38% vs. 18%, P = 0.100); however, there was no significant difference in morbidity and mortality.…”

Radiological Assessment of Sarcopenia and Its Clinical Impact in Patients with Hepatobiliary, Pancreatic, and Gastrointestinal Diseases: A Comprehensive Review

“…87 139 SMI was the most common parameter. Sarcopenia was associated with increased mortality, graft failure, reduced OS, and increased postoperative complications and infections in these studies, except for the study by Dhaliwal et al, 96 in which there was no difference in clinical outcomes between sarcopenic and nonsarcopenic patients. A study by van Vugt et al showed that sarcopenia is associated with increased health care costs and longer hospital stay following transplantation.…”

“…In this subgroup, there were 20 retrospective studies (4,168 patients) that assessed outcomes of sarcopenia in patients who underwent liver transplantation or had been waitlisted for the transplant procedure ( Table 5 ). 9 11 12 19 41 52 57 60 70 78 84 87 94 96 97 113 120 133 138 139…”

Osteoporosis and sarcopenia are common and insufficiently diagnosed among chronic pancreatitis patients

“…Psoas muscle area (PMA) was identified by CT or MRI scans gathered retrospectively within one year from the time when the DXA measurement was taken between the years 2018 and 2020 [ 19 ]. We calculated the mean area (mm 2 ) of both left and right psoas muscles from the middle of the third lumbar vertebra, so that both transverse processes were visible.…”