The aims of this study were to investigate
sarcopenia as a novel predictor of mortality and
sepsis after living donor
liver transplantation (LDLT) and to evaluate the effects of early
enteral nutrition on patients with
sarcopenia. Two hundred four patients undergoing preoperative computed tomography within the month before LDLT were retrospectively evaluated. The lengths of the major and minor axes of the psoas muscle were simply measured at the caudal end of the third lumbar vertebra, and the area of the psoas muscle was calculated. A psoas muscle area lower than the 5th percentile for healthy donors of each sex was defined as
sarcopenia. Ninety-six of the 204 patients (47.1%), including 58.3% (60/103) of the male patients and 35.6% (36/101) of the female patients, were diagnosed with
sarcopenia.
Sarcopenia was independently and significantly associated with overall survival: there was an approximately 2-fold higher risk of death for patients with
sarcopenia versus patients without
sarcopenia (hazard ratio = 2.06, P = 0.047).
Sarcopenia was an independent predictor of postoperative
sepsis (hazard ratio = 5.31, P = 0.009). Other independent predictors were a younger recipient age (P < 0.001) and a higher body mass index (P = 0.02). Early
enteral nutrition within the first 48 hours after LDLT was performed for 24.2% in 2003-2007 and for 100% in 2008-2011, and the incidence of postoperative
sepsis for patients with
sarcopenia (n = 96) was 28.2% (11/39) in 2003-2007 and 10.5% (6/57) in 2008-2011 (P = 0.03). In conclusion,
sarcopenia is an independent predictor of mortality and
sepsis after LDLT. The incidence of postoperative
sepsis was reduced even in patients with
sarcopenia after the routine application of early
enteral nutrition.