Reduced upper limb lean mass on dual energy X-ray absorptiometry predicts adverse outcomes in male liver transplant recipients

doi:10.5500/wjt.v12.i6.120

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Transplant. Jun 18, 2022; 12(6): 120-130
Published online Jun 18, 2022. doi: 10.5500/wjt.v12.i6.120

Table 1 Baseline patient characteristics based on gender and presence of sarcopenia defined by low appendicular lean mass[8]

	Non-sarcopenic (n = 355, 75.7%)	Sarcopenic (n = 114, 24.3%)	P value
Age, indication for transplantation	55 (48, 60)	54 (46, 58)	0.253
Viral hepatitis	106 (30%)	32 (28%)	0.715
Alcohol	30 (8%)	21 (18%)	0.003^a
Hepatoma	96 (27%)	26 (23%)	0.370
PBC/PSC/AIH	66 (19%)	18 (16%)	0.497
Bilirubin (μmol/L)	57 (28, 114)	47.5 (25, 91.5)	0.324
Albumin (g/L)	29 (24, 33)	30 (25, 25)	0.172
INR	1.4 (1.2, 1.7)	1.4 (1.2, 1.6)	0.786
Ascites	188 (53%)	71 (62%)	0.082
Encephalopathy	163 (46%)	57 (50%)	0.401
MELD score	16 (12, 20)	16 (12, 19)	0.934
Operative data
Total operative time (min)	465 (397, 534)	445 (291, 510)	0.162
Peak ALT	884 (509, 1525)	933 (496, 1494)	0.991
Cold ischaemic time (min)	381 (318, 479)	384 (303, 473)	0.530
Warm ischaemic time (min)	45 (39, 52)	44 (38, 50)	0.212
RBC transfusions (units)	2 (0, 4)	2 (0, 5)	0.008^a

^aP value < 0.05.

PBC: Primary biliary cholangitis; PSC: Primary sclerosing cholangitis; AIH: Autoimmune hepatitis; INR: International normalized ratio; MELD: Model for end stage liver disease; ALT: Alanine transaminase; RBC: Red blood cell.

Table 2 The association of pre-transplant variables and 180-d post-transplant sepsis

	Males (n = 338)		Females (n = 131)
	HR (95%CI)	P value	HR (95%CI)	P value
MELD	1.04 (1.00, 1.08)	0.051	1.06 (0.99, 1.12)	0.074
APLM	1.03 (0.87, 1.21)	0.76	0.93 (0.70, 1.24)	0.63
Upper limb LM	0.42 (0.20, 0.89)	0.024^a	0.74 (0.19, 2.95)	0.67
Lower limb LM	1.09 (0.92, 1.30)	0.33	0.93 (0.67, 1.28)	0.66
Total LM	1.07 (0.99, 1.15)	0.08	0.89 (0.76, 1.03)	0.12
Total fat mass	0.98 (0.91, 1.05)	0.50	0.99 (0.90, 1.08)	0.76
Ascites	2.18 (1.32, 3.59)	0.002^a	2.14 (0.95, 4.82)	0.06

^aP value < 0.05.

MELD: Model for end stage liver disease; APLM: Appendicular lean mass; LM: Lean mass; HR: Hazard ratio; CI: Confidence interval.

Table 3 The association of pre-transplant variables and acute cellular rejection within ninety days of liver transplantation

	Males (n = 338)		Females (n = 131)
	HR (95%CI)	P value	HR (95%CI)	P value
MELD	0.93 (0.89, 0.97)	0.002	1.04 (0.99, 1.09)	0.14
APLM	0.87 (0.72, 1.05)	0.16	1.10 (0.87. 1.4)	0.43
Upper limb LM	1.34 (0.67, 2.68)	0.41	0.43 (0.12, 1.51)	0.19
Lower limb LM	0.80 (0.63, 1.01)	0.063	1.17 (0.90, 1.52)	0.23
Total LM	0.83 (0.74, 0.92)	< 0.001^a	1.05 (0.95, 1.17)	0.32
Total fat mass	0.93 (0.87, 1.00)	0.062	1.03 (0.95, 1.12)	0.50
BMI	0.91 (0.86, 0.96)	< 0.001^a	1.02 (0.97, 1.08)	0.45
Ascites	0.43 (0.26, 0.70)	< 0.001^a	1.51 (0.76, 3.00)	0.24

^aP value < 0.05.

MELD: Model for end stage liver disease; APLM: Appendicular lean mass; LM: Lean mass; BMI: Body mass index; HR: Hazard ratio; CI: Confidence interval.

Table 4 Correlation of variables at transplant assessment with post-transplant total hospital and intensive care length of stay

	Males (n = 338)				Females (n = 131)
	Correlation¹ (τ_b)	P value¹	Correlation² (τ_b)	P value²	Correlation¹ (τ_b)	P value¹	Correlation² (τ_b)	P value²
Age	< -0.001	0.98	0.055	0.14	0.084	-0.18	0.047	0.44
Total APLM	-0.027	0.48	-0.004	0.91	-0.029	0.65	-0.012	0.84
Upper limb LM	-0.10	0.0078^a	-0.090	0.015^a	-0.079	0.21	0.019	0.75
Lower limb LM	< 0.001	0.99	0.017	0.64	-0.018	0.76	-0.018	0.76
Total LM	0.32	0.037^a	0.055	0.13	-0.012	0.84	-0.012	0.84
Total fat mass	0.036	0.33	0.048	0.20	0.039	0.53	0.039	0.53
MELD	0.078	0.045^a	0.0087	0.058	-0.037	0.56	0.087	0.17

^aP value < 0.05.

¹Correlation of variables at transplant assessment with post-transplant total hospital length of stay.

²Correlation of variables at transplant assessment with post-transplant intensive care length of stay.

APLM: Appendicular lean mass; LM: Lean mass; MELD: Model for end stage liver disease.

Table 5 Correlation of model for end stage liver disease score and body composition parameters

	Males (τ_b)	P value	Females (τ_b)	P value
APLM	0.071	0.056	0.15	0.01^a
Upper limb LM	-0.14	< 0.001^a	-0.077	0.20
Lower limb LM	0.12	< 0.001^a	0.18	0.0024^a
Total LM	0.22	< 0.001^a	0.18	0.0036^a
Fat mass	-0.04	0.27	-0.097	0.11

^aP value < 0.05.

APLM: Appendicular lean mass; LM: Lean mass.

Citation: Hey P, Hoermann R, Gow P, Hanrahan TP, Testro AG, Apostolov R, Sinclair M. Reduced upper limb lean mass on dual energy X-ray absorptiometry predicts adverse outcomes in male liver transplant recipients. World J Transplant 2022; 12(6): 120-130
URL: https://www.wjgnet.com/2220-3230/full/v12/i6/120.htm
DOI: https://dx.doi.org/10.5500/wjt.v12.i6.120