Liver transplantation arrests and reverses muscle wasting.

Abstract

Muscle wasting, sarcopenia, is common in advanced cirrhosis and predicts adverse outcomes while awaiting and following liver transplantation. Frequent post-transplant worsening of sarcopenia has attracted recent interest. It is unknown whether this serious problem is an expected metabolic consequence of transplantation or results from confounding conditions such as recurrent allograft liver disease or avoidable post-transplant complications. To clarify this question, we studied pre- and post-transplant muscle mass in a retrospective cohort of 40 patients transplanted for three diseases - alcoholic cirrhosis, non-alcoholic steatohepatitis cirrhosis, and primary sclerosing cholangitis cirrhosis - in whom allograft disease recurrence was monitored and excluded, and who lacked common post-transplant muscle wasting complications such as sepsis, renal failure, ischemia, and cholestasis. We measured skeletal muscle index (SMI) using computed tomography before and 12-48 months after transplant. SMI as a categorical variable significantly improved, from 18 patients above the normal cutoff pre-transplant to 28 post-transplant (p = 0.008). SMI increases were greatest in patients with the lowest pre-transplant SMI (p < 0.01). As a continuous variable, mean SMI remained stable, with a non-significant trend toward improvement. We conclude that after liver transplantation sarcopenia does not progress but is arrested and frequently improves in the absence of confounding conditions.

• Authors: Joseph T Bergerson, Jun-Goo Lee, Alessandro Furlan, Achuthan Sourianarayanane, David T Fetzer, Amit D Tevar, Douglas P Landsittel, Andrea F DiMartini, Michael A Dunn
• Journal: Clinical transplantation (Clin Transplant) Vol. 29 Issue 3 Pg. 216-21 (Mar 2015) ISSN: 1399-0012 [Electronic] Denmark
• PMID: 25557648 (Publication Type: Journal Article, Observational Study, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Topics

• Adult
• Aged
• Confounding Factors, Epidemiologic
• Female
• Humans
• Linear Models
• Liver Cirrhosis (etiology, surgery)
• Liver Transplantation
• Logistic Models
• Male
• Middle Aged
• Postoperative Complications (diagnosis, etiology)
• Preoperative Period
• Retrospective Studies
• Risk Factors
• Sarcopenia (diagnosis, etiology)
• Treatment Outcome