Advances in TransplantationLiver transplantationPerioperative Changes in the Psoas Muscle Index in Patients Undergoing ABO-Incompatible Living-Donor Liver Transplantation: A Single-Center Experience
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.
References (30)
- et al.
Trends in organ donation and transplantation in the United States, 1999-2008
Am J Transplant
(2010) - et al.
Impact of rituximab desensitization on blood-type-incompatible adult living donor liver transplantation: a Japanese multicenter study
Am J Transplant
(2014) - et al.
Sarcopenia and mortality after liver transplantation
J Am Coll Surg
(2010) - et al.
Risk factors for loss of lean body mass after liver transplantation
Appl Radiat Isot
(1998) - et al.
ABO-incompatible living donor liver transplantation is suitable in patients without ABO-matched donor
J Hepatol
(2013) - et al.
Mammalian target of rapamycin complex 1 activation is required for the stimulation of human skeletal muscle protein synthesis by essential amino acids
J Nutr
(2011) - et al.
The effect of tacrolimus (FK506) on intestinal barrier function and cellular energy production in humans
Gastroenterology
(1998) - et al.
Impact of sarcopenia on survival in patients undergoing living donor liver transplantation
Am J Transplant
(2013) - et al.
Liver transplantation: past, present and future
Nat Rev Gastroenterol Hepatol
(2013) Live donor liver transplantation in adults
Transplantation
(2006)