Impact of sarcopenic obesity on outcomes in patients undergoing living donor liver transplantation

Background & aim: Sarcopenia is known to be a poor prognostic factor after liver transplantation (LT). However, the significance of obesity in combination with sarcopenia (sarcopenic obesity) remains unclear. This study examined the impact of sarcopenic obesity on outcomes after living donor LT (LDLT). Methods: We retrospectively analyzed 277 adult patients who underwent LDLT at our center between January 2008 and June 2016. Body composition parameters including skeletal muscle mass index (SMI), intramuscular adipose tissue content (IMAC), visceral fat area (VFA), and visceral-to-subcutaneous adipose tissue area ratio (VSR) were evaluated by preoperative plain computed tomography imaging at the level of the third lumbar vertebra. This study defined sarcopenic obesity as a low SMI (male <40.31 cm(2)/m(2); female <30.88 cm(2)/m(2)) with VFA >= 100 cm(2) or body mass index (BMI) >= 25 kg/m(2). We examined outcomes among four groups: nonsarcopenic/nonobesity (NN), nonsarcopenic/obesity (NO), sarcopenic/ nonobesity (SN), and sarcopenic/obesity (SO) groups. Results: On the basis of VFA, 1/5-year overall survival (OS) rates in patients of SN (n = 46, 59%/46%, P < 0.001) and SO (n = 9, 56%/56%, P = 0.338) groups were lower than those in patients of the NN group (86%/80%). On the other hand, on the basis of BMI, 1/5-year OS rates in patients of SN (n = 49, 59%/52%, P < 0.001) and SO (n = 6, 50%/17%, P = 0.002) groups were significantly lower than those in patients of the NN group (87%/81%). Multivariate analysis identified ABO incompatibility (P = 0.030), low SMI (P = 0.002), high IMAC (P = 0.002), and high VSR (P < 0.001) as independent risk factors for death after LT. Conclusion: Patients with sarcopenic obesity showed worse survival after LDLT compared with nonsarcopenic/nonobesity patients. (C) 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.