Severe muscle depletion predicts postoperative length of... : Liver Transplantation (original) (raw)

Original Articles

Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation

Montano-Loza, Aldo J.1,2; Meza-Junco, Judith4; Baracos, Vickie E.4; Prado, Carla M. M.5; Ma, Mang M.D.1,2; Meeberg, Glenda3; Beaumont, Crystal4; Tandon, Puneeta1,2; Esfandiari, Nina4; Sawyer, Michael B.4; Kneteman, Norman3

1_Division of Gastroenterology, University of Alberta Hospital, Edmonton, Canada_

2_Liver Unit, University of Alberta Hospital, Edmonton, Canada_

3_Division of Transplantation Department of Surgery, University of Alberta Hospital, Edmonton, Canada_

4_Department of Oncology, Cross Cancer Institute, Edmonton, Canada_

5_Department of Nutrition, Food, and Exercise Sciences, Florida State University, Tallahassee, FL,_

Abbreviations AILD; autoimmune liver disease; BIA; bioelectrical impedance analysis; BMI; body mass index; CI; confidence interval; CT; computed tomography; DXA; dual-energy X-ray absorptiometry; HBV; hepatitis B virus; HCC; hepatocellular carcinoma; HCV; hepatitis C virus; HR; hazard ratio; INR; international normalized ratio; L3; third lumbar vertebra; SMI; skeletal muscle index; MELD; Model for End-Stage Liver Disease; NASH. nonalcoholic steatohepatitis.

Received 22 October 2013; Accepted 30 January 2014

Address reprint requests to Aldo J. Montano-Loza, M.D., M.Sc., Ph.D., Zeidler Ledcor Centre, University of Alberta, 130 University Campus, Edmonton, Alberta, T6G 2X8, Canada. Telephone: 780-248-1892; FAX: 780-248-1895; E-mail: [email protected]

This study was presented in part at the annual Liver Meeting of the American Association for the Study of Liver Diseases, November 10, 2012, Boston, MA.

The authors have no conflicts of interest to declare.

This study was funded by a Clinical Research Award from the American College of Gastroenterology Institute (2011).

Abstract

Muscle depletion or sarcopenia is associated with increased mortality in patients with cirrhosis; how it affects mortality after liver transplantation requires further study. In this study, we aimed to establish whether sarcopenia predicts increased morbidity or mortality after liver transplantation. We analyzed 248 patients with cirrhosis who had a computed tomography (CT) scan including the third lumbar vertebra before liver transplantation. Data were recovered from medical charts, the skeletal muscle cross-sectional area was measured with CT, and sarcopenia was defined with previously published sex- and body mass index–specific cutoffs. One hundred sixty-nine patients (68%) were male, and the mean age at transplantation was 55 ± 1 years. The etiologies of cirrhosis were hepatitis C virus (51%), alcohol (19%), autoimmune liver diseases (15%), hepatitis B virus (8%), and other etiologies (7%). Sarcopenia was present in 112 patients (45%), and it was more frequent in males (P = 0.002), patients with ascites (P = 0.02), and patients with higher bilirubin levels (P = 0.05), creatinine levels (P = 0.02), international normalized ratios (P = 0.04), Child-Pugh scores (P = 0.002), and Model for End-Stage Liver Disease scores (P = 0.002). The median survival period after liver transplantation was 117 ± 17 months for sarcopenic patients and 146 ± 20 months for nonsarcopenic patients (P = 0.4). Sarcopenic patients had longer hospital stays (40 ± 4 versus 25 ± 3 days; P = 0.005) and a higher frequency of bacterial infections within the first 90 days after liver transplantation (26% versus 15%, P = 0.04) in comparison with nonsarcopenic patients. In conclusion, sarcopenia is one of the most common complications in patients with cirrhosis and is predictive of longer hospital stays and a higher risk of perioperative bacterial infections after liver transplantation, but it is not associated with increased mortality. Liver Transpl 20:640–648, 2014. © 2014 AASLD.