Preoperative Assessment of Muscle Mass Using Computerized Tomography Scans to Predict Outcomes Following Orthotopic Liver Transplantation

Esser, Hannah; Resch, Thomas; Pamminger, Mathias; Mutschlechner, Beatrix; Troppmair, Jakob; Riedmann, Marina; Gassner, Eva; Maglione, Manuel; Margreiter, Christian; Boesmueller, C.; Oberhuber, Rupert; Weißenbacher, Annemarie; Cardini, Benno; Finkenstedt, Armin; Zoller, Heinz; Tilg, Herbert; Öfner, Dietmar; Schneeberger, Stefan

doi:10.1097/tp.0000000000002759

Cited by 25 publications

(19 citation statements)

References 46 publications

(72 reference statements)

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“…This technique also provides data on the mean skeletal muscle radiodensity, quoted in Hounsfield Units (HU), which is a surrogate marker of muscle quality and an indication of the presence of myosteatosis, as well as adiposity in terms of both visceral and subcutaneous fat cross-sectional area and indices. There is a large volume of literature linking preoperative sarcopenia in a range of different pathologies, including pancreatic surgery [27], gastric cancer surgery [28], esophageal cancer [29], liver transplantation [30] and colorectal cancer [31] to worsened clinical outcomes and overall survival. The strength of this relationship is even greater when the presence of sarcopenia is combined with obesity, i.e.…”

Section: Sarcopeniamentioning

confidence: 99%

Perioperative nutrition: Recommendations from the ESPEN expert group

et al. 2020

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Background & aims: Malnutrition has been recognized as a major risk factor for adverse postoperative outcomes. The ESPEN Symposium on perioperative nutrition was held in Nottingham, UK, on 14e15 October 2018 and the aims of this document were to highlight the scientific basis for the nutritional and metabolic management of surgical patients. Methods: This paper represents the opinion of experts in this multidisciplinary field and those of a patient and caregiver, based on current evidence. It highlights the current state of the art. Results: Surgical patients may present with varying degrees of malnutrition, sarcopenia, cachexia, obesity and myosteatosis. Preoperative optimization can help improve outcomes. Perioperative fluid therapy should aim at keeping the patient in as near zero fluid and electrolyte balance as possible. Similarly, glycemic control is especially important in those patients with poorly controlled diabetes, with a stepwise increase in the risk of infectious complications and mortality per increasing HbA1c. Immobilization can induce a decline in basal energy expenditure, reduced insulin sensitivity, anabolic resistance to protein nutrition and muscle strength, all of which impair clinical outcomes. There is a role for pharmaconutrition, pre-, pro-and syn-biotics, with the evidence being stronger in those undergoing surgery for gastrointestinal cancer.

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Section: Sarcopeniamentioning

confidence: 99%

Perioperative nutrition: Recommendations from the ESPEN expert group

et al. 2020

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“…prevalence of sarcopenia from cross-sectional CT images in adults on the waiting list for liver transplantation (LT) ranges between 40% and 70%. (2,7,8) Sarcopenia in adults is associated with increased wait-list morbidity and mortality caused by sepsis and infections (9) and impaired posttransplant outcomes, including decreased patient survival, (1,2,(10)(11)(12) increased serious infection, (11,(13)(14)(15)(16) prolonged intubation (11,17) with longer duration of intensive care unit (ICU) stay, (11,17,18) longer overall hospitalization, (11,19) rejection, (20) graft survival, (21) and postoperative complications. (14,18,22,23) Sarcopenia contributes to impaired growth and outcomes in pediatric chronic conditions, such as leukemia, inflammatory bowel disease, and chronic liver/intestinal failure.…”

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confidence: 99%

Sarcopenia in Children With End‐Stage Liver Disease on the Transplant Waiting List

et al. 2021

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Sarcopenia predicts morbidity and mortality in adults with end-stage liver disease (ESLD) and is determined by total psoas muscle area (tPMA) measurement from computed tomography (CT) imaging. Recently developed pediatric age-and sex-specific tPMA growth curves provide the opportunity to ascertain the prevalence and impact of sarcopenia in children awaiting liver transplantation (LT). We performed a retrospective single-center study to evaluate sarcopenia in children with ESLD between 1 and 16 years of age with a clinically indicated abdominal CT less than 3 months before first isolated LT. Sarcopenia was defined as a tPMA z score less than −2 measured at the intervertebral L4-5 level. Patient demographic, biochemical, and outcome data were recorded. tPMA was compared to other measures of nutritional and growth status using univariate and multivariate logistic analyses. Outcome measures included 1-year morbidity events and mortality after LT. CT images from 25 (64% female) children with a median age of 5.50 (interquartile range [IQR], 3.75, 11.33) years were reviewed. Of the 25 children with ESLD, 10 (40%) had a tPMA z score less than −2. Sarcopenia was associated with lower z scores for weight (odds ratio [OR], 0.38; P = 0.02) and height (OR, 0.32; P = 0.03) and nutritional support before LT (OR, 12.93; P = 0.01). Patients with sarcopenia had a longer duration of pediatric intensive care unit (PICU) stay (3.50 [IQR, 3.00, 6.00] vs. 2.00 [IQR, 2.00, 3.50] days; P = 0.03). Sarcopenia was prevalent in 40% of children with ESLD who underwent clinically indicated CT while awaiting LT, and lower tPMA z score was associated with anthropometrics and need for nutritional support before LT. Post-LT PICU duration was increased in children with sarcopenia, reflecting adverse outcomes associated with muscle loss. Further studies are needed to elucidate the underlying mechanisms of sarcopenia in children with ESLD. Sarcopenia, defined as a decrease in skeletal muscle mass and function, is a frequent finding in adults with cirrhosis. (1-3) In a recent consensus statement by the North American Working Group on Sarcopenia in Liver Transplantation, computed tomography (CT) assessment of total psoas muscle area (tPMA) was recommended as the gold-standard technique to assess sarcopenia in patients with cirrhosis. (4) Unaffected by ascites, tPMA is linearly related to whole body mass, providing an estimation of overall lean muscle mass in patients with end-stage liver disease (ESLD).

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“…Afterwards, samples were immediately transferred to Allprotect Tissue Reagent (Qiagen, Hilden, Germany). Deceased donor LT was performed according to previously described techniques ( 10 ). Triple immunosuppression regimen was implemented as described earlier ( 10 ).…”

Section: Methodsmentioning

confidence: 99%

“…Deceased donor LT was performed according to previously described techniques ( 10 ). Triple immunosuppression regimen was implemented as described earlier ( 10 ). The study was approved by the local Ethics Committee (UN5054, 324/4.13) and all experiments were conducted in compliance with the Declarations of Helsinki and Istanbul.…”

Section: Methodsmentioning

confidence: 99%

Expression of MICA in Zero Hour Biopsies Predicts Graft Survival After Liver Transplantation

et al. 2021

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In search for novel biomarkers to assess graft quality, we investigated whether defined candidate genes are predictive for outcome after liver transplantation (LT).Zero-hour liver biopsies were obtained from 88 livers. Gene expression of selected candidate markers was analyzed and correlated with clinical parameters as well as short and long-term outcomes post LT. Whereas both, the calculated Eurotransplant Donor-Risk-Index and the donor body mass index, had either a poor or no predictive value concerning serum levels indicative for liver function (ALT, AST, GGT, bilirubin) after 6 months, chronological donor age was weakly predictive for serum bilirubin (AUC=0.67). In contrast, the major histcompatibility complex class I related chain A (MICA) mRNA expression demonstrated a high predictive value for serum liver function parameters revealing an inverse correlation (e.g. for ALT: 3 months p=0.0332; 6 months p=0.007, 12 months 0.0256, 24 months p=0.0098, 36 months, p=0.0153) and proved significant also in a multivariate regression model. Importantly, high expression of MICA mRNA revealed to be associated with prolonged graft survival (p=0.024; log rank test) after 10 years of observation, whereas low expression was associated with the occurrence of death in patients with transplant related mortality (p=0.031). Given the observed correlation with short and long-term graft function, we suggest MICA as a biomarker for pre-transplant graft evaluation.

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Preoperative Assessment of Muscle Mass Using Computerized Tomography Scans to Predict Outcomes Following Orthotopic Liver Transplantation

Cited by 25 publications

References 46 publications

Perioperative nutrition: Recommendations from the ESPEN expert group

Perioperative nutrition: Recommendations from the ESPEN expert group

Sarcopenia in Children With End‐Stage Liver Disease on the Transplant Waiting List

Expression of MICA in Zero Hour Biopsies Predicts Graft Survival After Liver Transplantation

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