Background: Sarcopenia is reported as an adverse prognostic factor in various diseases. We investigated whether the preoperative sarcopenia status has some impacts on the postoperative outcomes after adult living-donor liver transplantation (LDLT).
Material/Methods: Adult recipients who underwent LDLT in our department between 2005 and 2017 (n=100) were subjected to this study. The recipients were divided into the sarcopenia and non-sarcopenia groups (S and N groups, respectively) based on the skeletal muscle index (SMI, skeletal mass area at the third lumbar vertebrae (L3) level (cm2) / height2 (m2)). SMI was measured on the preoperative plain CT images using an analyzer SYNAPSE VINCENT (Fujifilm, Tokyo, Japan). We defined sarcopenia as a skeletal muscle index (SMI)< 42 cm2/m2 (male) and < 38 cm2/m2 (female) according to criteria for determination of sarcopenia in liver diseases established by the Japan Society of Hepatology. The recipients in S and N groups were further divided into subgroups depending on the ABO blood-type compatibility. We compared clinical parameters between the groups or subgroups. We performed multivariate analyses to identify predictive factors for infection, rejection and survival.
Results: The incidence of bacterial infection was significantly higher in the S group (n=47) compared to N group (n=53). The incidence of rejection (acute cellular rejection and antibody mediated rejection) was significantly lower in the S group compared to the N group. A statistically significant difference was also detected in the comparison of incidence of rejection between the non-ABO incompatible in S and N groups. There was no significant difference in rate of discharge from hospital between the groups. The 3- and 5- year overall survival rates were 82.1 % and 82.1 % in the S group, and 76.6 % and 73.2 % in the N group, respectively. There was no significant difference in overall survival between the S and N groups. A multivariate analysis indicated that sarcopenia was significant predictive factor for bacterial infection and rejection. In the multivariate analysis for survival, biliary reconstruction (hepaticojejunostomy), older donor (≥40 years), small graft size (GRWR<0.8) and performing EEN were significant prognostic factors for post-transplant survival, but sarcopenia was not a significant prognostic factor.
Conclusions: Although sarcopenia recipients had equivalent overall survival rate to non-sarcopenia recipients under the current postoperative management, sarcopenia had an impact on the postoperative incidences of bacterial infection and rejection.