Sarcopenia is a prognostic factor in living donor liver transplantation

Abstract

The aims of this study were to investigate sarcopenia as a novel predictor of mortality and sepsis after living donor liver transplantation (LDLT) and to evaluate the effects of early enteral nutrition on patients with sarcopenia. Two hundred four patients undergoing preoperative computed tomography within the month before LDLT were retrospectively evaluated. The lengths of the major and minor axes of the psoas muscle were simply measured at the caudal end of the third lumbar vertebra, and the area of the psoas muscle was calculated. A psoas muscle area lower than the 5th percentile for healthy donors of each sex was defined as sarcopenia. Ninety-six of the 204 patients (47.1%), including 58.3% (60/103) of the male patients and 35.6% (36/101) of the female patients, were diagnosed with sarcopenia. Sarcopenia was independently and significantly associated with overall survival: there was an approximately 2-fold higher risk of death for patients with sarcopenia versus patients without sarcopenia (hazard ratio 5 2.06, P 5 0.047). Sarcopenia was an independent predictor of postoperative sepsis (hazard ratio 5 5.31, P 5 0.009). Other independent predictors were a younger recipient age (P < 0.001) and a higher body mass index (P 5 0.02). Early enteral nutrition within the first 48 hours after LDLT was performed for 24.2%

Systematic Review and Meta-Analysis of the Impact of Computed Tomography–Assessed Skeletal Muscle Mass on Outcome in Patients Awaiting or Undergoing Liver Transplantation

“…The prevalence greatly depended on the definition used. All studies that reported the prevalence of sarcopenia separately for males and females reported a higher prevalence among males (12,14,17,(21)(22)(23)(24)(25)(26)30).…”

“…From these 28 records, eight studies assessed muscle mass with means other than CT and one study was performed in a population other than patients awaiting or undergoing liver transplantation. The remaining 19 studies, including 3803 patients in partly overlapping cohorts, were included in this systematic review (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Cross-referencing yielded no additional records.…”

“…The methods of muscle measurement and sarcopenia definitions that were used are summarized in Table 2. Nine studies reported the cross-sectional muscle area with corresponding skeletal muscle index (12)(13)(14)17,(22)(23)(24)(25)30), whereas the psoas area was reported in eight studies (15,16,18,19,21,(26)(27)(28) and the dorsal muscle group area was reported in one study (20). One study calculated the morphometric age (calculated with total psoas area, psoas density, and abdominal aortic calcifications) (29).…”

“…The mean skeletal muscle index ranged from 43.0 to 54.3 cm²/m² (13,30). The prevalence of sarcopenia was reported in 17 studies (12)(13)(14)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)30) and ranged from 22.2% (30) to nearly 70% (13). The prevalence greatly depended on the definition used.…”

“…In the 11 studies that investigated the association between skeletal muscle mass and posttransplantation survival, seven described an association (13,14,16,18,20,21,29), and three gave no association (17,24,27,28). All details about median survival times, yearly survival rates, and the association between skeletal muscle mass and overall survival are summarized in Table 4.…”