Impact of sarcopenia on post-liver transplant morbidity and mortality in cirrhotic patients

Vijosh V Kumar; Sunil Raviraj Kothakota; Ajith K Nair; Madhu Sasidharan; Harish Kareem; Jagadeswarareddy Kanala; C Praveen Kumar

doi:10.1007/s12664-022-01262-3

Impact of sarcopenia on post-liver transplant morbidity and mortality in cirrhotic patients

Indian J Gastroenterol. 2022 Oct;41(5):440-445. doi: 10.1007/s12664-022-01262-3. Epub 2022 Nov 7.

Authors

Vijosh V Kumar¹, Sunil Raviraj Kothakota², Ajith K Nair¹, Madhu Sasidharan¹, Harish Kareem¹, Jagadeswarareddy Kanala¹, C Praveen Kumar¹

Affiliations

¹ Department of Gastroenterology, KIMS Hospital, P.O. Box: Anayara PO, Trivandrum, 695 029, India.
² Department of Gastroenterology, KIMS Hospital, P.O. Box: Anayara PO, Trivandrum, 695 029, India. ksrdnb@gmail.com.

PMID: 36342633
DOI: 10.1007/s12664-022-01262-3

Abstract

Background: Modalities available for severity assessment and prediction of complications after liver transplant (LT) in cirrhotic patients are model for end-stage liver disease-sodium (MELD-Na) and Child-Turcotte-Pugh (CTP) scores. The limitation of these scores is the lack of assessment of nutritional and functional status. Sarcopenia is a newer modality, which is developed for objective assessment of nutritional status. The aim of this study is to analyze the significance of sarcopenia in predicting 1-year mortality and morbidity in post-LT patients.

Methods: In this retrospective study, patients who underwent LT for cirrhosis between January 2013 and December 2018 were included. A computerized tomography (CT) image was used to analyze the psoas muscle index at the L3 vertebra (L3-PMI), and sarcopenia was defined as the values belonging to the lowest quartile of L3-PMI. The effect of sarcopenia on mortality and morbidity in terms of requirement for mechanical ventilation, duration of hospital stay, and occurrence of infections was studied.

Results: Among the study population (n = 74), 71 were men and the mean age was 51 years. Sarcopenia was observed in 27% (n = 20). Fifteen recipients had mortality within 1 year after transplant. In our analysis, sarcopenia was significantly associated with 1-year mortality (sensitivity 60%, specificity 81%; positive predictive value [PPV] 45%; negative predictive value [NPV] 88%; and p-value 0.001). Duration of mechanical ventilation, total hospital stay, and occurrence of infection were not significantly associated with sarcopenia. Sarcopenia was found as an independent predictor of mortality on binary logistic regression.

Conclusion: The preoperative sarcopenia index in cirrhotic patients can predict the risk of mortality in post-liver transplant patients.

Keywords: CTP score; Chronic liver disease; Computerized tomography; Liver transplant; MELD-sodium score; Malnutrition; Nutrition in cirrhosis; Psoas muscle index; Royal Free Hospital global assessement; Sarcopenia.

MeSH terms

End Stage Liver Disease*
Female
Humans
Liver Cirrhosis / complications
Liver Cirrhosis / surgery
Liver Transplantation* / adverse effects
Male
Middle Aged
Morbidity
Prognosis
Retrospective Studies
Sarcopenia* / complications
Sarcopenia* / etiology
Severity of Illness Index