Association Between Survival After Living Donor Liver Transplantation and Recipient Systemic Inflammation and Body...

Area of Science:

• Hepatology
• Transplantation Surgery
• Geriatrics

Background:

• Preoperative sarcopenia is a known predictor of poor outcomes in liver transplantation (LT).
• Systemic inflammatory status (SIS) is implicated in skeletal muscle loss, suggesting a combined effect with sarcopenia on LT prognosis.
• Assessing both SIS and sarcopenia may improve risk stratification for LT recipients.

Purpose of the Study:

• To investigate the relationship between SIS and skeletal muscle index (SMI) with mortality in living donor liver transplantation (LDLT) recipients.
• To evaluate the combined prognostic value of sarcopenia and SIS for short-term and long-term survival after LDLT.

Main Methods:

• Retrospective analysis of 3387 adult LDLT recipients.
• Neutrophil-to-lymphocyte ratio (NLR > 3) used as a marker for SIS.
• Skeletal muscle index (SMI) calculated from CT scans with sex-specific cut-offs.
• Univariate and multivariable Cox proportional hazard analyses performed.

Main Results:

• Decreasing SMI correlated with increasing NLR.
• Both increasing NLR and decreasing SMI showed a dose-dependent association with 90-day mortality.
• Sarcopenia combined with NLR > 3 independently predicted higher 90-day and overall mortality (HRs 2.48 and 1.81, respectively).
• The association between sarcopenia and mortality persisted across subgroups, notably higher in women.

Conclusions:

• Sarcopenia and systemic inflammation (NLR > 3) significantly increase 90-day and overall mortality risk post-LT, nearly doubling the hazard.
• These readily available biomarkers provide a practical index for predicting LT survival.
• Addressing these potentially modifiable factors could represent a therapeutic target for improving post-LT outcomes.