Living donor liver transplantation: "Sarcopenia was an independent predictor of post-operative sepsis"

Liver Transpl. 2013 Dec 20. doi: 10.1002/lt.23811. [Epub ahead of print]

Sarcopenia is a Prognostic Factor in Living Donor Liver Transplantation.

Masuda T, Shirabe K, Ikegami T, Harimoto N, Yoshizumi T, Soejima Y, Uchiyama H, Ikeda T, Baba H, Maehara Y.

Author information

• Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.

Abstract

The aim of this study was to investigate sarcopenia as a novel predictor for mortality and sepsis after living donor liver transplantation (LDLT), and to evaluate the effect of early enteral nutrition in patients with sarcopenia. A total of 204 patients with preoperative CT within 1 month before living-donor liver transplantation 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. Lower than the 5 percentile of the healthy donors' psoas muscle area of each gender was defined as sarcopenia. Ninety-six of all the 204 patients (47.1%), 58.3% (60 of 103) in male, and 35.6% (36 of 101) in female patients were diagnosed as sarcopenia. Sarcopenia was independently and significantly associated with overall survival, with a 2-fold higher risk of death in patients with sarcopenia compared to those without (HR; 2.06, p = 0.047). Sarcopenia was an independent predictor of post-operative sepsis (HR = 5.31, p = 0.009). Other independent predictors were younger recipient age (p < 0.001) and higher body mass index (p = 0.02). Early enteral nutrition within 48 hours after LDLT was performed in 24.2% in 2003 - 2007 and 100% in 2008 - 2011, and the incidence of postoperative sepsis in patients with sarcopenia (n = 96) was 28.2% (11/39) in the group of 2003 - 2007 and 10.5% (6/57) in the group of 2008 - 2011 (p = 0.03). Sarcopeniais an independent predictor of mortality and sepsis after LDLT. The incidence of postoperative sepsis reduced even in patients with sarcopenia after applying a routine early enteral nutrition.