Sarcopenia in Cirrhosis: Fallout on Liver Transplantation

Abstract

Liver transplantation (LT) is a game changer in cirrhosis. Poor muscle mass defined as sarcopenia may potentially upset the LT scoreboard. To assess the prevalence and impact of sarcopenia on the intraoperative and early postoperative outcomes in Indian patients undergoing LT. 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 m2 - skeletal muscle index (SMI; cm2/m2). 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. Sarcopenia was found in 47.8% of patients [M (90.4%); age, 46.3± 10; BMI, 24.5± 4.3kg/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. 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.