Elsevier

Transplantation Proceedings

Volume 49, Issue 9, November 2017, Pages 2144-2152
Transplantation Proceedings

Contributions in Transplantation
Liver transplantation
Clinical Outcomes of Living Liver Transplantation According to the Presence of Sarcopenia as Defined by Skeletal Muscle Mass, Hand Grip, and Gait Speed

https://doi.org/10.1016/j.transproceed.2017.09.017Get rights and content

Highlights

  • Sarcopenia is defined as reduced skeletal muscle mass plus low muscle strength.

  • Skeletal muscle area, hand-grip strength, and gait speed were prospectively measured in 102 patients who underwent LDLT.

  • Reduced skeletal muscle mass plus low muscle strength predicted surgical outcomes in patients who had undergone LDLT.

Abstract

Background

Sarcopenia is an independent predictor of death after living-donor liver transplantation (LDLT). However, the ability of the Asian Working Group for Sarcopenia criteria for sarcopenia (defined as reduced skeletal muscle mass plus low muscle strength) to predict surgical outcomes in patients who have undergone LDLT has not been determined.

Methods

This study prospectively enrolled 366 patients who underwent LDLT at Kyushu University Hospital. Skeletal muscle area (determined by computed tomography), hand-grip strength, and gait speed were measured in 102 patients before LDLT. We investigated the relationship between sarcopenia and surgical outcomes after LDLT performed in three time periods.

Results

The number of patients with lower skeletal muscle area has increased to 52.9% in recent years. The incidence of sarcopenia according to the Asian Working Group for Sarcopenia criteria was 23.5% (24/102). Patients with sarcopenia (defined by skeletal muscle area and functional parameters) had significantly lower skeletal muscle area and weaker hand-grip strength than did those without sarcopenia. Compared with non-sarcopenic patients, patients with sarcopenia also had significantly worse liver function, greater estimated blood loss, greater incidence of postoperative complications of Clavien-Dindo grade IV or greater (including amount of ascites on postoperative day 14, total bilirubin on postoperative day 14, and postoperative sepsis), and longer postoperative hospital stay. Multiple logistic regression analysis revealed sarcopenia as a significant predictor of 6-month mortality.

Conclusions

The combination of skeletal muscle mass and function can predict surgical outcomes in LDLT patients.

Section snippets

Patient Characteristics

LDLT was performed in 366 patients at Kyushu University Hospital from January 2001 to December 2016 after study approval was obtained from the Ethics and Indications Committee of Kyushu University. Patients with fulminant hepatic failure were excluded. Data from 102 patients who underwent LDLT from April 2014 to December 2016 were recorded prospectively. Patients were divided into 3 periods for analysis: period 1, 2001 to 2007 (n = 94); period 2, 2008 to 2013 (n = 170); and period 3, 2014 to

Results

Table 1 shows the comparison of clinical and surgical features between time periods. Low SMA was found in 23.5% (n = 94) of all transplant recipients, and the number of patients with low SMA increased to 52.9% in period 3. There were significant differences between periods in recipient sex, SMA, HCC, major shunt vessels, model for end-stage liver disease (MELD) score, PV pressure at laparotomy, operation time, blood loss, sepsis, duration of hospital stay, donor age, cold ischemic time, graft

Discussion

The present results showed that low SMA reflected poor liver function and poor outcome after LDLT in periods 1 and 2 (Table 2). However, this did not apply to recent patients; low skeletal muscle mass reflected poor liver function but not poor outcome in period 3 (Table 3). The number of sarcopenic patients is increasing, but improvements in peri-operative management have overcome the effects of sarcopenia. For this reason, we investigated the relationship between muscle strength and clinical

Conclusions

Assessments of skeletal muscle mass and function predict duration of hospital stay and incidence of postoperative septic shock in LDLT recipients more accurately than assessing only skeletal muscle mass. In recent LDLT cases, sarcopenia predicted the 6-month mortality. Hand-grip and gait speed tests are easy to perform, providing objective evaluations of muscle strength before LDLT. Treatment of sarcopenia may improve morbidity rates after liver transplantation. Further studies in larger

Acknowledgments

We thank Kelly Zammit, BVSc, from the Edanz Group (www.edanzediting.com/ac), for editing a draft of the manuscript.

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