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Sarcopenia Is Associated with Altered Rocuronium Onset and Neuromuscular Blockade Kinetics in Liver Transplant
Emre Arikan1, Neslihan Altunkaya Yagci1, Sami Akbulut2,3
1Department of Anesthesiology and Reanimation, Inonu University Faculty of Medicine, 44280 Malatya, Türkiye.
Journal of Clinical Medicine
|May 27, 2026
Summary
Sarcopenia in liver transplant recipients is linked to delayed rocuronium effect and worse outcomes. This highlights the need to consider sarcopenia for personalized perioperative care and neuromuscular management.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Hepatology and Transplant Surgery
- Geriatrics and Gerontology
Background:
- Sarcopenia is common in end-stage liver disease, impacting surgical outcomes.
- The relationship between sarcopenia and rocuronium's effects during liver transplantation is not well understood.
Purpose of the Study:
- To investigate the association between sarcopenia, neuromuscular blockade kinetics, and clinical outcomes in liver transplant recipients.
Main Methods:
- Prospective observational study of 139 liver transplant recipients.
- Classified patients as sarcopenic or non-sarcopenic using EWGSOP2 criteria (SARC-F, handgrip strength, psoas muscle index).
- Monitored rocuronium's neuromuscular blockade onset (T0) using train-of-four (TOF) and analyzed clinical outcomes.
Main Results:
- Sarcopenic patients had significantly lower psoas muscle index and handgrip strength.
- Sarcopenia was independently associated with a delayed onset of complete neuromuscular blockade (T0) (adjusted ratio = 1.232, p < 0.001).
- Sarcopenic recipients experienced prolonged extubation times, longer ICU stays, and significantly higher mortality (27.1% vs. 8.7%, p = 0.009).
Conclusions:
- Sarcopenia alters rocuronium pharmacodynamics, causing delayed neuromuscular blockade onset in liver transplant patients.
- Sarcopenia is an independent predictor of mortality in this population.
- Integrating sarcopenia assessment into risk stratification and tailoring neuromuscular management is crucial for liver transplant recipients.
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