Psoas Muscle Density in Combination with Model for End-Stage Liver Disease Score Can Improve Survival Predictability in Transjugular Intrahepatic Portosystemic Shunts

Shoreibah, Mohamed; Mahmoud, Khalid; Aboueldahab, Noha; Lune, Patrick Vande; Massoud, Moustafa; Bae, Sejong; Khudari, Husameddin El; Gunn, Andrew J.; Aal, Ahmed Kamel Abdel

doi:10.1016/j.jvir.2018.10.006

Cited by 22 publications

(15 citation statements)

References 49 publications

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“…Our results were in line with several previous studies showing the same correlation between sarcopenia and poor survivals in LT candidates and transplanted patients 7‐12 . Sarcopenia represents a sort of double‐edged sword.…”

Section: Discussionsupporting

confidence: 93%

“…Other ‘urgency’ 10‐12,24 and post‐LT ‘futility’ 8,9,13,15,25 models integrating sarcopenia and liver function surrogates have been previously proposed, all of them being in line with the results of the present study. Table reports a summary of these articles.…”

Section: Discussionsupporting

confidence: 90%

“…Sarcopenia is defined as a muscle disease caused by a degenerative loss of skeletal muscle mass, quality and strength associated with aging and immobility. Sarcopenia is considered a component of the frailty syndrome, and it is commonly observed in patients with cirrhosis 7‐12 …”

Section: Methodsmentioning

confidence: 99%

“…Several studies have shown that sarcopenia may be associated with cirrhotic patients with more dropouts, longer post‐LT stays and higher early post‐LT death rates 7‐9 . Some attempts to create a score integrating sarcopenia and MELD have been made 10‐12 . However, no study has investigated the creation of an ‘urgency’ model integrating sarcopenia and liver function models, simultaneously investigating (a) the risk of dropout during the waiting time and (b) a ‘futility’ cut‐off for transplant, namely a pre‐LT value predicting successful transplantation as an unrealistic goal.…”

Section: Introductionmentioning

confidence: 99%

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Sarco‐Model: A score to predict the dropout risk in the perspective of organ allocation in patients awaiting liver transplantation

Lai

Magistri

Lionetti

et al. 2021

Liver International

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Background & Aims Sarcopenia in liver transplantation (LT) cirrhotic candidates has been connected with higher dropouts and graft losses after transplant. The study aims to create an ‘urgency’ model combining sarcopenia and Model for End‐stage Liver Disease Sodium (MELDNa) to predict the risk of dropout and identify an appropriate threshold of post‐LT futility. Methods A total of 1087 adult cirrhotic patients were listed for a first LT during January 2012 to December 2018. The study population was split into a training (n = 855) and a validation set (n = 232). Results Using a competing‐risk analysis of cause‐specific hazards, we created the Sarco‐Model2. According to the model, one extra point of MELDNa was added for each 0.5 cm2/m2 reduction of total psoas area (TPA) < 6.0 cm2/m2. At external validation, the Sarco‐Model2 showed the best diagnostic ability for predicting the risk of 3‐month dropout in patients with MELDNa < 20 (area under the curve [AUC] = 0.93; P = .003). Using the net reclassification improvement, 14.3% of dropped‐out patients were correctly reclassified using the Sarco‐Model2. As for the futility threshold, transplanted patients with TPA < 6.0 cm2/m2 and MELDNa 35‐40 (n = 16/833, 1.9%) had the worse results (6‐month graft loss = 25.5%). Conclusions In sarcopenic patients with MELDNa < 20, the ‘urgency’ Sarco‐Model2 should be used to prioritize the list, while MELDNa value should be preferred in patients with MELDNa ≥ 20. The Sarco‐Model2 played a role in more than 30% of the cases in the investigated allocation scenario. In sarcopenic patients with a MELDNa value of 35‐40, ‘futile’ transplantation should be considered.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sarco‐Model: A score to predict the dropout risk in the perspective of organ allocation in patients awaiting liver transplantation

Lai

Magistri

Lionetti

et al. 2021

Liver International

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“…Similarly, the persistence of sarcopenia after TIPS is associated with a reduced response to TIPS and a higher risk of acute-on-chronic liver failure development and mortality[ 199 ]. A retrospective observational study found that the measurement of psoas muscle density improved overall survival predictability in patients with cirrhosis undergoing TIPS creation when used in conjunction with the MELD score[ 200 ]. Another retrospective study found that sarcopenic obesity is a risk factor for mortality after TIPS and contributes additional prognostic information beyond the MELD score[ 201 ].…”

Section: Considerations During Selection Of Patients For Tipsmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update

Rajesh

George

Philips

et al. 2020

WJG

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More than five decades after it was originally conceptualized as rescue therapy for patients with intractable variceal bleeding, the transjugular intrahepatic portosystemic shunt (TIPS) procedure continues to remain a focus of intense clinical and biomedical research. By the impressive reduction in portal pressure achieved by this intervention, coupled with its minimally invasive nature, TIPS has gained increasing acceptance in the treatment of complications of portal hypertension. The early years of TIPS were plagued by poor long-term patency of the stents and increased incidence of hepatic encephalopathy. Moreover, the diversion of portal flow after placement of TIPS often resulted in derangement of hepatic functions, which was occasionally severe. While the incidence of shunt dysfunction has markedly reduced with the advent of covered stents, hepatic encephalopathy and instances of early liver failure continue to remain a significant issue after TIPS. It has emerged over the years that careful selection of patients and diligent post-procedural care is of paramount importance to optimize the outcome after TIPS. The past twenty years have seen multiple studies redefining the role of TIPS in the management of variceal bleeding and refractory ascites while exploring its application in other complications of cirrhosis like hepatic hydrothorax, portal hypertensive gastropathy, ectopic varices, hepatorenal and hepatopulmonary syndromes, non-tumoral portal vein thrombosis and chylous ascites. It has also been utilized to good effect before extrahepatic abdominal surgery to reduce perioperative morbidity and mortality. The current article aims to review the updated literature on the status of TIPS in the management of patients with liver cirrhosis.

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Psoas Muscle Density Predicts Occurrences of Hepatic Encephalopathy in Patients Receiving Transjugular Intrahepatic Portosystemic Shunts within 1 year

Cai

Lin

et al. 2021

Cardiovasc Intervent Radiol

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Psoas Muscle Density in Combination with Model for End-Stage Liver Disease Score Can Improve Survival Predictability in Transjugular Intrahepatic Portosystemic Shunts

Cited by 22 publications

References 49 publications

Sarco‐Model: A score to predict the dropout risk in the perspective of organ allocation in patients awaiting liver transplantation

Sarco‐Model: A score to predict the dropout risk in the perspective of organ allocation in patients awaiting liver transplantation

Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update

Psoas Muscle Density Predicts Occurrences of Hepatic Encephalopathy in Patients Receiving Transjugular Intrahepatic Portosystemic Shunts within 1 year

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