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