Abstract
To evaluate the association between sarcopenia and tumor recurrence after living donor liver transplantation (LDLT) in patients with advanced hepatocellular carcinoma (HCC), we analyzed 92 males who underwent LDLT for treating HCC beyond the Milan criteria. Sarcopenia was defined when the height-normalized psoas muscle thickness was <15.5 mm/m at the L3 vertebra level on computed tomography based on an optimum stratification method using the Gray’s test statistic. Survival analysis was performed with death as a competing risk event. The primary outcome was post-transplant HCC recurrence. The median follow-up time was 36 months. There was a 9% increase in recurrence risk per unit decrease in height-normalized psoas muscle thickness. Twenty-six (36.1%) of 72 sarcopenic recipients developed HCC recurrence, whereas only one (5.0%) of 20 non-sarcopenic recipients developed HCC recurrence. Recurrence risk was greater in sarcopenic patients in univariable analysis (hazard ratio [HR] = 8.06 [1.06–16.70], p = 0.044) and in multivariable analysis (HR = 9.49 [1.18–76.32], p = 0.034). Greater alpha-fetoprotein and microvascular invasion were also identified as independent risk factors. Incorporation of sarcopenia improved the model fitness and prediction power of the estimation model. In conclusion, sarcopenia appears to be one of the important host factors modulating tumor recurrence risk after LDLT for advanced HCC.
Highlights
Liver transplantation is an established therapeutic option to treat hepatocellular carcinoma (HCC) because it removes both the tumor and surrounding premalignant parenchymal tissues
We evaluated the relationship between sarcopenia and tumor recurrence after living donor liver transplantation (LDLT) in patients with advanced HCC exceeding the Milan criteria (HCC beyond the Milan criteria)
This study demonstrated that sarcopenia was independently associated with tumor recurrence after LDLT in male patients with advanced HCC
Summary
Liver transplantation is an established therapeutic option to treat hepatocellular carcinoma (HCC) because it removes both the tumor and surrounding premalignant parenchymal tissues. As one way to overcome the graft shortage, liver transplantation of grafts from living donors, so-called living donor liver transplantation (LDLT), allows more advanced HCC to be treated because living donors decide to donate at their own will and generally request permission to donate their grafts to a specific recipient without graft competition[2]. In this regard, better understanding of factors contributing to tumor recurrence of this highly invasive cancer is required to compensate for the high recurrence risk and improve post-transplant outcomes after LDLT. Surgical factors Operative time > 10 hours Perioperative RBC transfusion > 6 units Tacrolimus trough concentration > 10 ng/mL
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