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. 2022 Jan;12(1):215-228.
doi: 10.21037/qims-21-314.

Sarcopenia defined by psoas muscle index independently predicts long-term survival after living donor liver transplantation in male recipients

Yifei Tan #  1 , Ting Duan #  2 , Bo Li  1 , Bohan Zhang  1 , Yunfeng Zhu  1 , Ke Yan  3 , Jiulin Song  1 , Tao Lv  1 , Jian Yang  1 , Li Jiang  1 , Jiayin Yang  1 , Tianfu Wen  1 , Lunan Yan  1
Affiliations

Sarcopenia defined by psoas muscle index independently predicts long-term survival after living donor liver transplantation in male recipients

Yifei Tan et al. Quant Imaging Med Surg. 2022 Jan.

Abstract

Background: The effect of sarcopenia on long-term outcomes in recipients after living donor liver transplantation (LDLT), including overall survival and hepatocellular carcinoma (HCC) recurrence, remains unclear, especially in China.

Methods: From 2009 to 2015, 117 adult patients underwent LDLT in our center. In all, 82 patients who had computed tomography images reaching the third lumbar vertebra level within 1 month of LDLT were included; 70 male patients were included in the final analysis after excluding 12 female patients because of poor performance of the calculated cutoff value. Sarcopenia was defined according to the psoas muscle index (PMI) cutoff value, which was calculated based on dynamic time-dependent outcomes using X-tile software. Cox proportional hazards models were used to assess multivariate-adjusted hazards ratios (HRs) to seek potential correlations between sarcopenia and posttransplant outcomes.

Results: According to the cutoff value of PMI (6.25 cm2/m2), 38 patients (54.3%) were diagnosed with sarcopenia. After an average of 63.3 months of follow-up, 21 patients died after LDLT, 16 in the sarcopenia group and 5 in the non-sarcopenia group, respectively. Sarcopenia was identified as being significantly associated with worse posttransplant overall survival in multivariate analysis, resulting in an HR of 3.22 [95% confidence interval (CI), 1.15-8.98]. Among the 50 recipients with HCC, sarcopenia was significantly associated with HCC recurrence in univariate analysis (HR 2.87, 95% CI, 1.06-7.80) but was not detected as an independent risk factor of HCC recurrence in multivariate analysis, although a trend (tendency)towards significance was observed (HR 2.60, 95% CI, 0.95-7.10; P=0.062).

Conclusions: Sarcopenia defined by PMI is a feasible and reliable independent predictor of posttransplant overall survival in male LDLT candidates. However, its correlation with posttransplant HCC recurrence remains uncertain.

Keywords: Sarcopenia; cutoff value; living donor liver transplantation (LDLT); psoas muscle index (PMI).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the International Committee of Medical Journal Editors (ICMJE) uniform disclosure form (available at https://dx.doi.org/10.21037/qims-21-314). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The measurement of psoas muscle area of both sides (1, right; 2, left) on computed tomography slides. (A) An example of the range of bilateral psoas muscle; (B) an example of area measurement of bilateral psoas muscle. The area of the left psoas muscle is 838.8 mm2 and that of the right psoas muscle is 699.5 mm2.
Figure 2
Figure 2
Distributions of psoas muscle index and calculation of optimal cutoff values. Histograms and X-tile plots of psoas muscle index according to survival outcomes of all patients (A,B), females (C,D), and males (E,F). PMI, psoas muscle index.
Figure 3
Figure 3
Cumulative overall survival in patients with and without sarcopenia.
Figure 4
Figure 4
Cumulative overall survival and recurrence-free survival after living donor liver transplantation stratified by sarcopenia and meeting Milan criteria. (A,B) Overall survival according to sarcopenia and Milan criteria status. (C,D) Recurrence-free survival according to sarcopenia and Milan criteria status.
See this image and copyright information in PMC

References

    1. Raia S, Nery JR, Mies S. Liver transplantation from live donors. Lancet 1989;2:497. 10.1016/S0140-6736(89)92101-6 - DOI - PubMed
    1. Rosenberg I. Epidemiologic and methodologic problems in determining nutritional status of older persons.(Summary comments). Am J Clin Nutr 1989;50:1231-3. 10.1093/ajcn/50.5.1231 - DOI - PubMed
    1. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M, European Working Group on Sarcopenia in Older People . Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39:412-23. 10.1093/ageing/afq034 - DOI - PMC - PubMed
    1. Anand AC. Nutrition and Muscle in Cirrhosis. J Clin Exp Hepatol 2017;7:340-57. 10.1016/j.jceh.2017.11.001 - DOI - PMC - PubMed
    1. Cruz RJ, Jr, Dew MA, Myaskovsky L, Goodpaster B, Fox K, Fontes P, DiMartini A. Objective radiologic assessment of body composition in patients with end-stage liver disease: going beyond the BMI. Transplantation 2013;95:617-22. 10.1097/TP.0b013e31827a0f27 - DOI - PMC - PubMed