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Association between sarcopenia and the risk of serious infection among adults undergoing liver transplantation.
Liver Transpl 2013; 19(12):1396-402LT

Abstract

Although sarcopenia (muscle loss) is associated with increased mortality after liver transplantation, its influence on other complications is less well understood. We examined the association between sarcopenia and the risk of severe posttransplant infections among adult liver transplant recipients. By calculating the total psoas area (TPA) on preoperative computed tomography scans, we assessed sarcopenia among 207 liver transplant recipients. The presence or absence of a severe posttransplant infection was determined by a review of the medical chart. The influence of posttransplant infections on overall survival was also assessed. We identified 196 episodes of severe infections among 111 patients. Fifty-six patients had more than 1 infection. The median time to the development of an infection was 27 days (interquartile range = 13-62 days). When the patients were grouped by TPA tertiles, patients in the lowest tertile had a greater than 4-fold higher chance of developing a severe infection in comparison with patients in the highest tertile (odds ratio = 4.6, 95% confidence interval = 2.25-9.53). In a multivariate analysis, recipient age (hazard ratio = 1.04, P = 0.02), pretransplant TPA (hazard ratio = 0.38, P < 0.01), and pretransplant total bilirubin level (hazard ratio = 1.05, P = 0.02) were independently associated with the risk of developing severe infections. Patients with severe posttransplant infections had worse 1-year survival than patients without infections (76% versus 92%, P = 0.003). In conclusion, among patients undergoing liver transplantation, a lower TPA was associated with a heightened risk for posttransplant infectious complications and mortality. Future efforts should focus on approaches for assessing and mitigating vulnerability in patients undergoing transplantation.

Authors+Show Affiliations

Department of Surgery, University of Michigan Health System, Ann Arbor, MI.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24151041

Citation

Krell, Robert W., et al. "Association Between Sarcopenia and the Risk of Serious Infection Among Adults Undergoing Liver Transplantation." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 19, no. 12, 2013, pp. 1396-402.
Krell RW, Kaul DR, Martin AR, et al. Association between sarcopenia and the risk of serious infection among adults undergoing liver transplantation. Liver Transpl. 2013;19(12):1396-402.
Krell, R. W., Kaul, D. R., Martin, A. R., Englesbe, M. J., Sonnenday, C. J., Cai, S., & Malani, P. N. (2013). Association between sarcopenia and the risk of serious infection among adults undergoing liver transplantation. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 19(12), pp. 1396-402. doi:10.1002/lt.23752.
Krell RW, et al. Association Between Sarcopenia and the Risk of Serious Infection Among Adults Undergoing Liver Transplantation. Liver Transpl. 2013;19(12):1396-402. PubMed PMID: 24151041.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between sarcopenia and the risk of serious infection among adults undergoing liver transplantation. AU - Krell,Robert W, AU - Kaul,Daniel R, AU - Martin,Andrew R, AU - Englesbe,Michael J, AU - Sonnenday,Christopher J, AU - Cai,Shijie, AU - Malani,Preeti N, Y1 - 2013/10/21/ PY - 2013/06/07/received PY - 2013/08/30/accepted PY - 2013/10/24/entrez PY - 2013/10/24/pubmed PY - 2014/7/22/medline SP - 1396 EP - 402 JF - Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society JO - Liver Transpl. VL - 19 IS - 12 N2 - Although sarcopenia (muscle loss) is associated with increased mortality after liver transplantation, its influence on other complications is less well understood. We examined the association between sarcopenia and the risk of severe posttransplant infections among adult liver transplant recipients. By calculating the total psoas area (TPA) on preoperative computed tomography scans, we assessed sarcopenia among 207 liver transplant recipients. The presence or absence of a severe posttransplant infection was determined by a review of the medical chart. The influence of posttransplant infections on overall survival was also assessed. We identified 196 episodes of severe infections among 111 patients. Fifty-six patients had more than 1 infection. The median time to the development of an infection was 27 days (interquartile range = 13-62 days). When the patients were grouped by TPA tertiles, patients in the lowest tertile had a greater than 4-fold higher chance of developing a severe infection in comparison with patients in the highest tertile (odds ratio = 4.6, 95% confidence interval = 2.25-9.53). In a multivariate analysis, recipient age (hazard ratio = 1.04, P = 0.02), pretransplant TPA (hazard ratio = 0.38, P < 0.01), and pretransplant total bilirubin level (hazard ratio = 1.05, P = 0.02) were independently associated with the risk of developing severe infections. Patients with severe posttransplant infections had worse 1-year survival than patients without infections (76% versus 92%, P = 0.003). In conclusion, among patients undergoing liver transplantation, a lower TPA was associated with a heightened risk for posttransplant infectious complications and mortality. Future efforts should focus on approaches for assessing and mitigating vulnerability in patients undergoing transplantation. SN - 1527-6473 UR - https://www.unboundmedicine.com/medline/citation/24151041/Association_between_sarcopenia_and_the_risk_of_serious_infection_among_adults_undergoing_liver_transplantation_ L2 - https://doi.org/10.1002/lt.23752 DB - PRIME DP - Unbound Medicine ER -