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Sarcopenia and mortality after liver transplantation
Michael J Englesbe1, Shaun P Patel, Kevin He
1Department of Surgery, University of Michigan, Ann Arbor, MI, USA. englesbe@umich.edu
Journal of the American College of Surgeons
|July 31, 2010
Summary
Central sarcopenia, a measure of muscle loss, strongly predicts mortality after liver transplantation. Assessing this frailty can improve patient selection and outcomes for this major surgery.
Area of Science:
- Hepatology
- Transplantation Surgery
- Geriatric Medicine
Background:
- Determining patient suitability for liver transplantation remains a challenge for surgeons.
- Objective measures of disease burden, like sarcopenia, can aid clinical decisions and prevent futile transplantations.
Purpose of the Study:
- To investigate the association between psoas muscle cross-sectional area and post-transplantation mortality.
- To assess sarcopenia as a predictor of outcomes in liver transplant recipients.
Main Methods:
- Psoas muscle cross-sectional area was measured from CT scans of 163 liver transplant recipients.
- Cox regression models were used to analyze the relationship between psoas area and mortality, controlling for donor and recipient factors.
Main Results:
- Psoas area showed a significant inverse correlation with post-transplantation mortality (HR = 3.7 per 1,000 mm² decrease; P < 0.0001).
- One-year survival ranged from 49.7% (smallest psoas area quartile) to 87.0% (largest psoas area quartile).
- Three-year survival was 26.4% and 77.2% for the respective quartiles, with psoas area impacting survival more than other covariates.
Conclusions:
- Central sarcopenia is a strong predictor of mortality following liver transplantation.
- Objective frailty measures like sarcopenia can enhance clinical decision-making and potentially influence organ allocation policies.
- Further research is needed to develop validated and clinically applicable measures of sarcopenia and frailty in liver transplantation.