Comprehensive assessment of sarcopenia and its clinical significance in liver transplantation

Aidan J. Woodward, Matthew Wallen, Leigh C. Ward, Jeff Coombes, Graeme A. Macdonald

Research output: Contribution to journalMeeting Abstractpeer-review

Abstract

Introduction: Sarcopenia has been associated with an increased risk of pre- and post-liver transplant morbidity and mortality in patients with chronic liver disease (CLD). It is recommended that assessment of sarcopenia should involve measuring skeletal muscle mass (SMM), muscle strength, and physical performance using standardized criteria, such as the European Working Group on Sarcopenia in Older People (EWGSOP) guidelines.1 The aim of this investigation was to examine the prevalence of EWGSOP sarcopenia and explore the prognostic utility of each component in patients undergoing liver transplantation.

Patients and Methods: We prospectively recruited patients with CLD referred to the Queensland Liver Transplant Service. Assessment of sarcopenia was performed according to the guidelines of the EWGSOP, including measurement of SMM, muscle strength, and physical performance.1 SMM was measured using dual energy x-ray absorptiometry (DXA) appendicular lean mass and computed tomography (CT) skeletal muscle area at the level of the third lumbar vertebra. Muscle strength was assessed using isometric handgrip strength on the non-dominant side using a hand dynamometer. Physical performance was assessed using the Sit-to-Stand (STS) test, Short Physical Performance Battery (SPPB), 6-minute Walk Distance (6MWD), and stair climb test. Adverse waiting list outcomes, including hospital admission due to sepsis, hepatic encephalopathy, and gastrointestinal hemorrhage, were collected before transplant. Peri- and post-liver transplant (within 90 days) outcomes were recorded, including sepsis, delayed extubation (>8 hours), reoperation, prolonged intensive care unit length of stay (>3 days), and prolonged hospital length of stay (>21 days). Univariate binary logistic regression was performed for all binary outcomes to test the relationship with potential predictors, including age, MELD score, and etiology of CLD. To identify independent predictors, backward stepwise multiple logistic regression was performed.

Results: Sixty-eight patients (median age, 55 years [interquartile range, 46–60; 82% male) completed baseline testing, of whom 48 were listed for liver transplant and 44 received a liver transplant. According to the EWGSOP sarcopenia classification system, no patients had “severe sarcopenia,” seven patients (10.3%) had “sarcopenia,” and eight (11.8%) had “pre-sarcopenia.” Lower STS test score was independently associated with pre-transplant non-cholestatic sepsis (odds ratio [OR], 0.53; 95% CI, 0.33–0.83; P = 0.006) and hepatic encephalopathy admission (OR, 0.65; 95% CI, 0.44–0.98; P = 0.038). Lower DXA skeletal muscle index was associated with delayed extubation (OR, 0.39; 95% CI, 0.18–0.85; P = 0.022) and sepsis (OR, 0.22; 95% CI, 0.05–0.90; P = 0.036) after liver transplant. Impaired SPPB (OR, 18.80; 95% CI, 1.54–229.38; P = 0.022) was also an independent predictor of post-transplant sepsis, while an impaired 6MWD was a predictor of prolonged hospital stay (OR, 12.86; 95% CI, 1.16–142.9; P = 0.038).

Conclusion: Measures of SMM and physical performance demonstrated independent associations with pre- and post-transplant outcomes, including sepsis, hepatic encephalopathy admissions, delayed extubation, and prolonged hospital stay. The multi-component assessment of sarcopenia provides different prognostic information in patients with CLD undergoing liver transplantation. Comprehensive assessment of sarcopenia as recommended by the EWGSOP is supported by our results.
Original languageEnglish
Pages (from-to)s78
Number of pages1
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume33
Issue numberS2
DOIs
Publication statusPublished - Sep 2018
Externally publishedYes

Keywords

  • Sarcopenia
  • liver transplantation

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