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Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation.

Abstract

Muscle depletion or sarcopenia is associated with increased mortality in patients with cirrhosis; how it affects mortality after liver transplantation requires further study. In this study, we aimed to establish whether sarcopenia predicts increased morbidity or mortality after liver transplantation. We analyzed 248 patients with cirrhosis who had a computed tomography (CT) scan including the third lumbar vertebra before liver transplantation. Data were recovered from medical charts, the skeletal muscle cross-sectional area was measured with CT, and sarcopenia was defined with previously published sex- and body mass index-specific cutoffs. One hundred sixty-nine patients (68%) were male, and the mean age at transplantation was 55 ± 1 years. The etiologies of cirrhosis were hepatitis C virus (51%), alcohol (19%), autoimmune liver diseases (15%), hepatitis B virus (8%), and other etiologies (7%). Sarcopenia was present in 112 patients (45%), and it was more frequent in males (P = 0.002), patients with ascites (P = 0.02), and patients with higher bilirubin levels (P = 0.05), creatinine levels (P = 0.02), international normalized ratios (P = 0.04), Child-Pugh scores (P = 0.002), and Model for End-Stage Liver Disease scores (P = 0.002). The median survival period after liver transplantation was 117 ± 17 months for sarcopenic patients and 146 ± 20 months for nonsarcopenic patients (P = 0.4). Sarcopenic patients had longer hospital stays (40 ± 4 versus 25 ± 3 days; P = 0.005) and a higher frequency of bacterial infections within the first 90 days after liver transplantation (26% versus 15%, P = 0.04) in comparison with nonsarcopenic patients. In conclusion, sarcopenia is one of the most common complications in patients with cirrhosis and is predictive of longer hospital stays and a higher risk of perioperative bacterial infections after liver transplantation, but it is not associated with increased mortality.

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  • Authors+Show Affiliations

    ,

    Division of Gastroenterology, University of Alberta Hospital, Edmonton, Canada; Liver Unit, University of Alberta Hospital, Edmonton, Canada.

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    Source

    MeSH

    Adult
    Aged
    Bacterial Infections
    Female
    Humans
    Kaplan-Meier Estimate
    Length of Stay
    Liver Cirrhosis
    Liver Transplantation
    Male
    Middle Aged
    Multivariate Analysis
    Muscle, Skeletal
    Proportional Hazards Models
    Retrospective Studies
    Risk Factors
    Sarcopenia
    Severity of Illness Index
    Time Factors
    Tomography, X-Ray Computed
    Treatment Outcome
    Young Adult

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    24678005

    Citation

    Montano-Loza, Aldo J., et al. "Severe Muscle Depletion Predicts Postoperative Length of Stay but Is Not Associated With Survival After Liver Transplantation." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 20, no. 6, 2014, pp. 640-8.
    Montano-Loza AJ, Meza-Junco J, Baracos VE, et al. Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation. Liver Transpl. 2014;20(6):640-8.
    Montano-Loza, A. J., Meza-Junco, J., Baracos, V. E., Prado, C. M., Ma, M., Meeberg, G., ... Kneteman, N. (2014). Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 20(6), pp. 640-8. doi:10.1002/lt.23863.
    Montano-Loza AJ, et al. Severe Muscle Depletion Predicts Postoperative Length of Stay but Is Not Associated With Survival After Liver Transplantation. Liver Transpl. 2014;20(6):640-8. PubMed PMID: 24678005.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation. AU - Montano-Loza,Aldo J, AU - Meza-Junco,Judith, AU - Baracos,Vickie E, AU - Prado,Carla M M, AU - Ma,Mang, AU - Meeberg,Glenda, AU - Beaumont,Crystal, AU - Tandon,Puneeta, AU - Esfandiari,Nina, AU - Sawyer,Michael B, AU - Kneteman,Norman, Y1 - 2014/03/26/ PY - 2013/10/22/received PY - 2014/01/30/accepted PY - 2014/3/29/entrez PY - 2014/3/29/pubmed PY - 2015/1/31/medline SP - 640 EP - 8 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 - 20 IS - 6 N2 - Muscle depletion or sarcopenia is associated with increased mortality in patients with cirrhosis; how it affects mortality after liver transplantation requires further study. In this study, we aimed to establish whether sarcopenia predicts increased morbidity or mortality after liver transplantation. We analyzed 248 patients with cirrhosis who had a computed tomography (CT) scan including the third lumbar vertebra before liver transplantation. Data were recovered from medical charts, the skeletal muscle cross-sectional area was measured with CT, and sarcopenia was defined with previously published sex- and body mass index-specific cutoffs. One hundred sixty-nine patients (68%) were male, and the mean age at transplantation was 55 ± 1 years. The etiologies of cirrhosis were hepatitis C virus (51%), alcohol (19%), autoimmune liver diseases (15%), hepatitis B virus (8%), and other etiologies (7%). Sarcopenia was present in 112 patients (45%), and it was more frequent in males (P = 0.002), patients with ascites (P = 0.02), and patients with higher bilirubin levels (P = 0.05), creatinine levels (P = 0.02), international normalized ratios (P = 0.04), Child-Pugh scores (P = 0.002), and Model for End-Stage Liver Disease scores (P = 0.002). The median survival period after liver transplantation was 117 ± 17 months for sarcopenic patients and 146 ± 20 months for nonsarcopenic patients (P = 0.4). Sarcopenic patients had longer hospital stays (40 ± 4 versus 25 ± 3 days; P = 0.005) and a higher frequency of bacterial infections within the first 90 days after liver transplantation (26% versus 15%, P = 0.04) in comparison with nonsarcopenic patients. In conclusion, sarcopenia is one of the most common complications in patients with cirrhosis and is predictive of longer hospital stays and a higher risk of perioperative bacterial infections after liver transplantation, but it is not associated with increased mortality. SN - 1527-6473 UR - https://www.unboundmedicine.com/medline/citation/24678005/Severe_muscle_depletion_predicts_postoperative_length_of_stay_but_is_not_associated_with_survival_after_liver_transplantation_ L2 - https://doi.org/10.1002/lt.23863 DB - PRIME DP - Unbound Medicine ER -