Impact of sarcopenia on mortality in patients undergoing liver re-transplantation

Amaninder Dhaliwal; Diana Larson; Molly Hiat; Lyudmila M Muinov; William L Harrison; Harlan Sayles; Tomoki Sempokuya; Marco A Olivera; Fedja A Rochling; Timothy M McCashland

doi:10.4254/wjh.v12.i10.807

Impact of sarcopenia on mortality in patients undergoing liver re-transplantation

World J Hepatol. 2020 Oct 27;12(10):807-815. doi: 10.4254/wjh.v12.i10.807.

Affiliations

¹ Department of Gastroenterology and Hepatology, University of South Florida and Moffitt Cancer Center, Tampa, FL 33612, United States. dramaninderdhaliwal@gmail.com.
² Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States.
³ Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States.
⁴ Department of Radiology, University of Nebraska Medical Center, Omaha, NE 68198, United States.
⁵ Division of Abdominal Imaging, Department of Radiology, University of Nebraska Medical Center, Omaha, NE 68198, United States.
⁶ Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States.

Abstract

Background: Sarcopenia, which is a loss of skeletal muscle mass, has been reported to increase post-transplant mortality and morbidity in patients undergoing the first liver transplant. Cross-sectional imaging modalities typically determine sarcopenia in patients with cirrhosis by measuring core abdominal musculatures. However, there is limited evidence for sarcopenia related outcomes in patients undergoing liver re-transplantation (re-OLT).

Aim: To evaluate the risk of mortality in patients with pre-existing sarcopenia following liver re-OLT.

Methods: This is a retrospective study of all adult patients who had undergone a liver re-OLT at the University of Nebraska Medical Center from January 1, 2007 to January 1, 2017. We divided patients into sarcopenia and no sarcopenia groups. "TeraRecon AquariusNet 4.4.12.194" software was used to evaluate computed tomography or magnetic resonance imaging of the patients done within one year prior to their re-OLT, to calculate the Psoas muscle area at L3-L4 intervertebral disc. We defined cutoffs for sarcopenia as < 1561 mm² for males and < 1464 mm² for females. The primary outcome was to compare 90 d, one, and 5-year survival rates. We also compared complications after re-OLT, length of stay, and re-admission within 30 d. Survival analysis was performed with Kaplan-Meier survival analysis. Continuous variables were evaluated with Wilcoxon rank-sum tests. Categorical variables were evaluated with Fisher's exact tests.

Results: Fifty-seven patients were included, 32 males: 25 females, median age 50 years. Two patients were excluded due to incomplete information. Overall, 47% (26) of patients who underwent re-OLT had sarcopenia. Females were found to have significantly more sarcopenia than males (73% vs 17%, P < 0.001). Median model for end stage liver disease at re-OLT was 28 in both sarcopenia and no sarcopenia groups. Patients in the no sarcopenia group had a trend of longer median time between the first and second transplant (36.5 mo vs 16.7 mo). Biological markers, outcome parameters, and survival at 90 d, 1 and 5 years, were similar between the two groups. Sarcopenia in re-OLT at our center was noted to be twice as common (47%) as historically reported in patients undergoing primary liver transplantation.

Conclusion: Overall survival and outcome parameters were no different in those with and without the evidence of sarcopenia after re-OLT.

Keywords: Liver transplantation; Mortality; Psoas muscle index; Re-transplantation; Sarcopenia.