Abstract
Introduction The significance of preoperative body composition has recently attracted much attention in various diseases. However, cut-off values for these parameters remain undetermined, and these factors are not currently included in selection criteria for recipients of living donor liver transplantation (LDLT). The present study aimed to establish sex-specific cut-offs for body composition using data from healthy general population, and to develop new selection criteria for recipients of LDLT considering pre-transplant nutritional and physical statuses. Methods Using computed tomography of 657 donors for LDLT between April 2005 and July 2016 in our institution, skeletal muscle mass, muscle quality, and visceral adiposity were evaluated using skeletal muscle mass index (SMI), intramuscular adipose tissue content (IMAC), and visceral-to-subcutaneous adipose tissue area ratio (VSR). On the basis of younger donor data, we determined sex-specific cut-off values for low SMI, high IMAC, and high VSR (mean ± 2 standard deviations). To evaluate the validity of cut-offs for body composition parameters, we examined data from 277 patients who underwent adult-to-adult LDLT between January 2008 and July 2016. The impact of body composition on outcomes after LDLT was investigated with the aim of establishing new selection criteria for LDLT. Results Among the 277 LDLT recipients, 55 (20.0%), 121 (43.7%), and 83 (30.0%) patients exhibited low SMI, high IMAC, and high VSR, respectively. The overall survival rate was significantly lower for each group of patients with low SMI (P < 0.001), high IMAC (P < 0.001), or high VSR (P < 0.001) compared to the respective normal groups. In addition, low SMI, high IMAC, and high VSR contributed to an increased risk of post-LDLT mortality in an additive manner. Patients with all three factors showed the lowest survival rate after LDLT (1-year survival rate, 41.2%; P < 0.001). On multivariate analysis, low SMI (P = 0.002), high IMAC (P = 0.002), and high VSR (P = 0.001) were identified as independent risk factors for mortality after LDLT. Based on these findings, we have excluded patients showing all 3 factors (low SMI, high IMAC and high VSR) as candidates for LDLT since October 2016. Conclusion Using cut-off values determined from healthy donors, we investigated risk factors for post-LDLT mortality, and extracted the group that exhibited the poorest prognosis after LT, leading to the establishment of our new selection criteria for recipients of LDLT.
Highlights
Sarcopenia is characterized by age-related progressive and generalized decline in skeletal muscle mass and muscle strength and has been accepted worldwide as a new geriatric syndrome.[1]
Distributions of body composition according to sex and donor age Skeletal muscle mass index, intramuscular adipose tissue content (IMAC), and visceral-to-subcutaneous adipose tissue area ratio (VSR) differed significantly between men and women (P < 0.001 each) (Table 1)
In both men and women, weak-to-moderate, but statistically highly significant relationships were observed between donor age and skeletal muscle mass index (SMI), IMAC, and VSR
Summary
Sarcopenia is characterized by age-related progressive and generalized decline in skeletal muscle mass and muscle strength and has been accepted worldwide as a new geriatric syndrome.[1] Recent studies have reported significant associations between sarcopenia and poor outcomes in various diseases.[2,3,4,5,6,7] In the field of liver transplantation (LT), our recent studies have demonstrated that pre-operative low muscularity (low muscle mass and low muscle quality) shows a close correlation with post-transplant mortality.[8,9] On the other hand, high visceral adiposity calculated as the visceral-to-subcutaneous adipose tissue area ratio (VSR) has been reported as a useful predictor of poor outcomes in several cancers.[10,11,12] these body compositions have not been included in the current selection criteria for recipients for LT, because the method for measuring muscularity and visceral adiposity varies between investigations and because universally accepted cut-off values for these factors remain undetermined. Cut-off values for these parameters remain undetermined, and these factors are not currently included in selection criteria for recipients of living donor liver transplantation (LDLT)
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