Sarcopenia in Cirrhosis: Fallout on Liver Transplantation.

Autor: Kumar V; Department of Hepato Pancreato Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi, India., Benjamin J; Department of Clinical Nutrition, Institute of Liver and Biliary Sciences, New Delhi, India., Shasthry V; Department of Clinical Nutrition, Institute of Liver and Biliary Sciences, New Delhi, India., Subramanya Bharathy KG; Department of Hepato Pancreato Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi, India., Sinha PK; Department of Hepato Pancreato Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi, India., Kumar G; Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India., Pamecha V; Department of Hepato Pancreato Biliary and Liver Transplant Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.
Jazyk: angličtina
Zdroj: Journal of clinical and experimental hepatology [J Clin Exp Hepatol] 2020 Sep-Oct; Vol. 10 (5), pp. 467-476. Date of Electronic Publication: 2019 Dec 31.
DOI: 10.1016/j.jceh.2019.12.003
Abstrakt: Background: Liver transplantation (LT) is a game changer in cirrhosis. Poor muscle mass defined as sarcopenia may potentially upset the LT scoreboard.
Aim: To assess the prevalence and impact of sarcopenia on the intraoperative and early postoperative outcomes in Indian patients undergoing LT.
Methods: Pre LT, single-slice routine computed tomography images at L3 vertebra of 115 LT recipients were analyzed, to obtain cross-sectional area of six skeletal muscles normalized for height in m 2 - skeletal muscle index (SMI; cm 2 /m 2 ). SMI< 52.4 in males and <38.5 in females was called sarcopenia. The intraoperative, postoperative outcome parameters and 90-day mortality were compared between sarcopenics and nonsarcopenics.
Results: Sarcopenia was found in 47.8% of patients [M (90.4%); age, 46.3 ± 10; BMI, 24.5 ± 4.3 kg/m2; child A:B:C = 1%:22%:77%; MELD, 20.6 ± 6.3; etiology alcohol: nonalchohol = 53%:47%; Charlson Comorbidity Index (CCI) > 3:≤3 = 56.5%:43.5%]. Sarcopenics vs. Nonsarcopenics; early postoperative complications: [sepsis, 49(89%) vs. 33(55%), P  = 0.001; neurologic complications, 16(29.6%) vs. 5(8.8%), P  = 0.040; Clavien-Dindo Classification ≥3-24 (43.6%):15 (25.4%), P  = 0.041; ancillary parameters (days), duration of ventilation [median (range)] 1.5(1-3) vs. 1 (1-2), P  = 0.021; intensive care unit (ICU) stay 12 (8-16) vs. 10 (8-12), P  = 0.024; time to ambulation 9 (7-11) vs. 6 (5-7), P  = 0.001; drain removal 18.7 ± 7.3 vs. 14.4 ± 6.2, P  = 0.001; need for tracheostomy 5 (9%) vs. 0 (%), P  = 0.017; preoperative prevalence of acute kidney injury, comorbidities and requirement for dialysis, intraoperative blood loss & inotropic support were significantly higher in sarcopenics. Ninety-day mortality was comparable between sarcopenics 5 (9.09%) and nonsarcopenics 4 (6.6%) P  = 0.63. SMI (OR: 0.83; 95% CI: 0.71-0.97, P  = 0.016; Acute on chronic liver failure (ACLF) presentation 12.5 (1.65-95.2), P  = 0.015 and intraoperative blood loss 3.74 (0.96-14.6), P  = 0.046 were predictors of 90-day mortality.
Conclusion: Almost 50% of LT recipients had sarcopenia, who had a higher incidence of postoperative sepsis, neurological complications, longer ICU stay and ventilatory support. Low SMI, ACLF presentation, and intraoperative blood loss were the independent predictors of early mortality.
(© 2019 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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