Preoperative low muscle mass has a strong negative effect on pulmonary function in patients undergoing living donor liver transplantation.

Abstract

This study investigated the effect of preoperative sarcopenia on cardiopulmonary function in patients undergoing living donor liver transplantation (LDLT). A retrospective analysis was performed of 207 patients who underwent LDLT between January 2008 and April 2015. The quantity and quality of skeletal muscle were evaluated by the psoas muscle mass index (PMI) and intramuscular adipose tissue content (IMAC), respectively, using preoperative computed tomography imaging. The correlations between preoperative cardiopulmonary function and sarcopenic factors (PMI, IMAC, and grip strength [GS]) were examined. Moreover, overall survival (OS) rates according to preoperative pulmonary function and risk factors were analyzed. No significant differences were found between ejection fraction (EF) and these sarcopenic factors. In contrast, preoperative vital capacity (VC) and forced expiratory volume (FEV) 1.0 were significantly correlated with PMI (P<0.001, P<0.001), IMAC (P=0.024, P=0.013), and GS (P=0.006, P=0.033) in males. Preoperative VC and FEV1.0 were significantly correlated with IMAC (P=0.002, P=0.001) and GS (P=0.002, P=0.001) in females. Moreover, %VC, VC, and FEV1.0 in the preoperative low muscle mass group were significantly lower than in the normal muscle mass group (P=0.004, P<0.001, P<0.001, respectively) in males. Multivariate analysis revealed that preoperative low PMI and preoperative restrictive ventilatory impairment were independent risk factors (P=0.046 and P=0.014, respectively). Preoperative low muscle mass was closely involved with pulmonary dysfunction in patients undergoing LDLT.