Perioperative Skeletal Muscle Fluctuations in High-Acuity Liver Transplantation

Background: Frailty has been implicated as a negative predictor of Liver Transplant (LT) out-comes. However, an understanding of changes in patient muscle mass peri-LT, and their effect in high-acuity patients remains lacking. We examined the impact of perioperative muscle mass changes (boolean AND SMI) on high-acuity (MELD >= 35) LT recipients. Materials and Methods: Skeletal muscle index (SMI) was calculated using CT imaging. Patients were divided into two groups, based on severity of peri-operative SMI decrease. LT recipients with chronic end-stage liver disease, MELD >= 35, and abdominal CT <= 30 days prior, and 30-90 days post LT were included. [1011 adult LT recipients reviewed, 2012-2018]. Results: Of 1011 patients reviewed, 88 met inclusion criteria (median MELD 41.1). The me-dian Delta 002;SMI was-5.0 (-29.4 -+ 21.1 cm(2)/m(2) ) (fig A). Patients were classified into two groups: Delta SMI <-5.0 (median Delta SMI:-0.4, n = 44) and Delta SMI> -5.0 (median Delta SMI:-9.2, n = 44). Recipients with Delta SMI< -5.0 had higher pre-LT SMI (35.4 versus 31.2 cm(2)/m(2) , P < 0.001) and lower post-LT SMI (26.0 versus 30.8 cm(2)/m(2) , P < 0.001). The Delta SMI< -5.0 group had higher early allograft dysfunction (40.9 versus 20.5%, P = 0.037), and inferior patient and graft survival (P = 0.015, 0.017, respectively). Multivariate analysis identified Delta SMI< -5.0 (HR: 2.938, P = 0.048), long cold-ischemia time (>9h, HR: 7.332, P = 0.008), HCV (HR: 5.614, p = 0.001), and tracheostomy after LT (HR:9.218, P < 0.001) as negative prognostic factors for patient survival . Conclusions: Progressive perioperative sarcopenic deterioration was associated with inferior patient and graft survival in high acuity LT. These findings may guide pre and post-operative patient care and rehabilitation efforts in this challenging patient population. (c) 2021 Elsevier Inc. All rights reserved.

Automated summary

The study found that a decrease in patient muscle mass perioperatively is associated with inferior patient and graft survival in high-acuity LT recipients. Pre- and post-operative patient care and rehabilitation efforts are crucial for this challenging patient population.