Elsevier

Transplantation Proceedings

Volume 50, Issue 10, December 2018, Pages 3656-3660
Transplantation Proceedings

Advances in Transplantation
Liver transplantation
Perioperative Changes in the Psoas Muscle Index in Patients Undergoing ABO-Incompatible Living-Donor Liver Transplantation: A Single-Center Experience

https://doi.org/10.1016/j.transproceed.2018.08.034Get rights and content

Highlights

  • Since the introduction of rituximab, ABO-incompatible living-donor liver transplantation has gradually become accepted as a feasible therapy for end-stage liver disease.

  • Patients with end-stage liver disease experience progressive muscle loss (sarcopenia) associated with poor posttransplantation outcomes.

  • We are the first to show that patients undergoing ABO-incompatible living-donor liver transplantation become maximally vulnerable to core muscle loss soon after surgery.

Abstract

Introduction

In the era of rituximab, ABO-incompatible living-donor liver transplantation (ABOi LDLT) is clinically accepted as a feasible therapy for end-stage liver disease. To date, no data on postoperative sarcopenic changes in patients undergoing ABOi LDLT are available.

Patients and methods

Thirty-six adult patients undergoing ABOi LDLT between October 2010 and July 2017 at our hospital were retrospectively analyzed. The cross-sectional areas of both psoas muscles between the third and fourth lumbar vertebrae were manually estimated from abdominal computed tomography images obtained within 1 month before surgery, and 1 and 3 weeks, 6 months, and 1 year after surgery. The mean psoas muscle areas were calculated and normalized by the height squared to create psoas muscle indices (PMIs).

Results

The PMIs on postoperative days (PODs) 7 and 21 were significantly lower than the preoperative PMI in each whole study and male cohort. In whole study cohort, the absolute and relative PMIs on POD 7 were 308.8 (271.5–375.8) mm2/m2 and 95.3% (89.9%–101.1%). On POD 21, the values were 297.8 (258.5–349.6) mm2/m2 and 90.7% (81.1%–99.2%). In men, they were 335.3 (276.7–389.4) mm2/m2 and 94.2% (89.0%–98.8%) on POD 7, and 305.0 (271.6–357.0) mm2/m2 and 89.2% (83.2%–98.2%) on POD 21. In women, they were 281.2 (231.1–313.7) mm2/m2 and 101.4% (95.2%–106.0%) on POD 7, and 260.7 (245.9–273.9) mm2/m2 and 98.9% (77.9%–124.3%) on POD 21.

Conclusion

Patients undergoing ABOi LDLT were most vulnerable to core muscle loss soon after surgery.

Section snippets

Study Population

A total of 36 adult patients (≥19 years old) underwent ABOi LDLT between October 2010 and July 2017 in our hospital. Recipient and donor data were retrospectively recovered from our electronic medical records system. The study was approved by the institutional review board of our hospital (approval no. KC18RESI0205) and was performed in accordance with all relevant tenets of the Declaration of Helsinki. Informed consent was waived because of the retrospective nature of the work.

ABO-Incompatible Living-Donor Liver Transplantation

The LDLT

Results

We evaluated 36 patients who underwent ABOi LDLT. The perioperative recipient- and donor-graft data are listed in Table 1. The median recipient age was 54 years (IQR: 50–57 years); most (80.6%) patients were male. The most common etiology triggering ABOi LDLT was hepatitis B infection (61.1%), and the median MELD score was 12 (7–16) points. The median surgical duration was 508 (458–554) min. In terms of blood product transfusion, the median packed red blood cell requirement was 7 (4–12) units

Discussion

After LT, patients with ESLD exhibit increased total protein loss (largely skeletal muscle mass); only 54% of the loss is recovered by 1 year. Prolonged posttransplantation hypermetabolism gradually depletes protein stores, which recover only incompletely; body composition and function are abnormal for at least 1 year after surgery [10]. In the first 3 months after LT, fat mass is more vigorously restored than skeletal muscle and lean body mass, causing long-term sarcopenia [11], [12]. Patients

Conclusion

We explored postoperative changes in PMI, a core muscle marker, in patients undergoing ABOi LDLT. Although we did not assess correlations between serial postoperative PMIs and postoperative outcomes, we are the first to show that ABOi LDLT patients are maximally vulnerable to core muscle loss soon after surgery. Further study of interventions such as nutritional or physical therapies seeking to improve muscle mass and function will help prevent sarcopenia in such patients.

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