Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2020; 12(10): 807-815
Published online Oct 27, 2020. doi: 10.4254/wjh.v12.i10.807
Impact of sarcopenia on mortality in patients undergoing liver re-transplantation
Amaninder Dhaliwal, Diana Larson, Molly Hiat, Lyudmila M Muinov, William L Harrison, Harlan Sayles, Tomoki Sempokuya, Marco A Olivera, Fedja A Rochling, Timothy M McCashland
Amaninder Dhaliwal, Department of Gastroenterology and Hepatology, University of South Florida and Moffitt Cancer Center, Tampa, FL 33612, United States
Diana Larson, Tomoki Sempokuya, Marco A Olivera, Fedja A Rochling, Timothy M McCashland, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
Molly Hiat, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
Lyudmila M Muinov, Department of Radiology, University of Nebraska Medical Center, Omaha, NE 68198, United States
William L Harrison, Division of Abdominal Imaging, Department of Radiology, University of Nebraska Medical Center, Omaha, NE 68198, United States
Harlan Sayles, Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States
Author contributions: Dhaliwal A was the guarantor of the article and designed the research study; Dhaliwal A and Larson D involved in data collection; Sayles H contributed statistical analysis; all authors were involved with data interpretation, drafting, editing, and critical revision of this manuscript; and all authors have read and approved the final manuscript. 
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Review Board (IRB# 236-17-EP).
Informed consent statement: Informed consent was not required to conduct this study.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available upon request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amaninder Dhaliwal, MD, Academic Fellow, Doctor, Division of Gastroenterology and Hepatology, University of South Florida and Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, United States. dramaninderdhaliwal@gmail.com
Received: April 11, 2020
Peer-review started: April 11, 2020
First decision: April 26, 2020
Revised: July 27, 2020
Accepted: October 5, 2020
Article in press: October 5, 2020
Published online: October 27, 2020
Processing time: 195 Days and 7.7 Hours
Abstract
BACKGROUND

Sarcopenia, which is a loss of skeletal muscle mass, has been reported to increase post-transplant mortality and morbidity in patients undergoing the first liver transplant. Cross-sectional imaging modalities typically determine sarcopenia in patients with cirrhosis by measuring core abdominal musculatures. However, there is limited evidence for sarcopenia related outcomes in patients undergoing liver re-transplantation (re-OLT).

AIM

To evaluate the risk of mortality in patients with pre-existing sarcopenia following liver re-OLT.

METHODS

This is a retrospective study of all adult patients who had undergone a liver re-OLT at the University of Nebraska Medical Center from January 1, 2007 to January 1, 2017. We divided patients into sarcopenia and no sarcopenia groups. “TeraRecon AquariusNet 4.4.12.194” software was used to evaluate computed tomography or magnetic resonance imaging of the patients done within one year prior to their re-OLT, to calculate the Psoas muscle area at L3-L4 intervertebral disc. We defined cutoffs for sarcopenia as < 1561 mm2 for males and < 1464 mm2 for females. The primary outcome was to compare 90 d, one, and 5-year survival rates. We also compared complications after re-OLT, length of stay, and re-admission within 30 d. Survival analysis was performed with Kaplan-Meier survival analysis. Continuous variables were evaluated with Wilcoxon rank-sum tests. Categorical variables were evaluated with Fisher’s exact tests.

RESULTS

Fifty-seven patients were included, 32 males: 25 females, median age 50 years. Two patients were excluded due to incomplete information. Overall, 47% (26) of patients who underwent re-OLT had sarcopenia. Females were found to have significantly more sarcopenia than males (73% vs 17%, P < 0.001). Median model for end stage liver disease at re-OLT was 28 in both sarcopenia and no sarcopenia groups. Patients in the no sarcopenia group had a trend of longer median time between the first and second transplant (36.5 mo vs 16.7 mo). Biological markers, outcome parameters, and survival at 90 d, 1 and 5 years, were similar between the two groups. Sarcopenia in re-OLT at our center was noted to be twice as common (47%) as historically reported in patients undergoing primary liver transplantation.

CONCLUSION

Overall survival and outcome parameters were no different in those with and without the evidence of sarcopenia after re-OLT.

Keywords: Sarcopenia; Liver transplantation; Mortality; Re-transplantation; Psoas muscle index

Core Tip: There is a limited data on outcomes among patients with sarcopenia undergoing re-transplantation of the liver. A retrospective study of 57 patients who underwent re-transplantation showed 47% of patients had sarcopenia by Psoas muscle index at the level of L3-L4 Intervertebral disc prior to re-transplantation. Biological markers, outcome parameters, and survival at 90 d, 1 and 5 years, were similar between the two groups. Sarcopenia in re-transplantation was noted to be twice as common as historically reported in patients undergoing primary liver transplantation.