The impact of sarcopenia and myosteatosis in liver transplant candidates on peritransplant course and patient and graft survival
Irena Míková1, Denisa Kyselová1, Dana Kautznerová Orcid.org 2, Marek Tupý2, Marek Kysela3, Věra Lánská Orcid.org 4, Julius Špičák Orcid.org 1, Jiří Froněk Orcid.org 5, Pavel Trunečka6
1 Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha
2 Pracoviště radiodiagnostiky a intervenční radiologie, IKEM, Praha
3 Klinika transplantační chirurgie, IKEM, Praha
4 Lékařská statistika, IKEM, Praha
5 Klinika transplantační chirurgie, Transplantcentrum, IKEM, Praha
6 Transplantcentrum, IKEM, Praha
Introduction: Sarcopenia (severe muscle depletion) and myosteaosis (pathological fat accumulation in muscle) are frequent muscle abnormalities in patients with cirrhosis associated with unfavorable prognosis. The aim of our study was to evaluate the impact of sarcopenia and myosteatosis in liver transplant (LT) candidates in our center on the peritransplant course and patient and graft survival. Methods: This prospective study included adult LT candidates who underwent clinical and laboratory examination. The skeletal muscle index (SMI) at L3 level and radiodensity of psoas major muscle (PM-RA) were evaluated by CT. Results: Pretransplant sarcopenia was found in 49 of 103 patients (47.6%) and myosteatosis in 53 (51.5%) patients. Patients with sarcopenia had lower BMI, waist circumference, occurrence of hypertension and metabolic syndrome and lower triglyceride and C-peptide levels than patients without sarcopenia. Patients with myosteatosis had higher Child-Pugh score and lower HDL-cholesterol levels than patients without myosteatosis. Pretransplant SMI negatively correlated with the amount of blood transfusions given during LT and occurrence of biliary complications. Patients with myosteatosis had higher need for blood transfusions during LT and after LT, and higher number of surgical revisions. Occurrence of sarcopenia had no significant effect on patient and graft survival. Patients with myosteatosis had worse long-term survival than patients without myosteatosis, the graft survival did not differ. Conclusion: Sarcopenia and myosteatosis are frequent muscle abnormalities in LT candidates with negative impact on peritransplant course. Myosteatosis was associated with a worse long-term survival in our study.
Key words: sarcopenia – myosteatosis – liver transplantation – prevalence – complications – survival
Keywordssarcopenia, myosteatosis, liver transplantation, prevalence, complication, survival
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1. Ebadi M, Montano-Loza AJ. Clinical relevance of skeletal muscle abnormalities in patients with cirrhosis. Dig liver Dis 2019; 51 (11): 1493–1499. doi: 10.1016/j.dld.2019.05.034.
2. Cruz-Jentoft AJ, Bahat G, Bauer J et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48 (1): 16–31. doi: 10.1093/ageing/afy169.
3. Carey EJ, Lai JC, Sonnenday C et al. A north American expert opinion statement on sarcopenia in liver transplantation. Hepatology 2019; 70 (5): 1816–1829. doi: 10.1002/hep.30 828.
4. Czigany Z, Kramp W, Bednarsch J et al. Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation. Am J Transplant 2020; 20 (2): 493–503. doi: 10.1111/ajt.15577.
5. van Vugt JL, Levolger S, de Bruin RW et al. Systematic review and meta-analysis of the impact of computed tomography-assessed skeletal muscle mass on outcome in patients awaiting or undergoing liver transplantation. Am J Transplant 2016; 16 (8): 2277–2292. doi: 10.1111/ajt.13732.
6. Sinclair M, Chapman B, Hoermann R et al. Handgrip Strength Adds More Prognostic Value to the Model for End-Stage Liver Disease Score Than Imaging-Based Measures of Muscle Mass in Men With Cirrhosis. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 2019; 25 (10): 1480–1487. doi: 10.1002/lt.25 598.
7. Bhanji RA, Moctezuma-Velazquez C, Duarte-Rojo A et al. Myosteatosis and sarcopenia are associated with hepatic encephalopathy in patients with cirrhosis. Hepatol Int 2018; 12 (4): 377–386. doi: 10.1007/s12072-018-9875-9.
8. Montano-Loza AJ, Meza-Junco J, Prado CMM, et al. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2012; 10 (2): 166–173, doi: 10.1016/j.cgh. 2011.08.028
9. Kim G, Kang SH, Kim MY et al. Prognostic value of sarcopenia in patients with liver cirrhosis: a systematic review and meta-analysis. PLoS One 2017; 12 (10): e0186990. doi: 10.1371/journal.pone.0186990.
10. Montano-Loza AJ, Angulo P, Meza-Junco J et al. Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis. J Cachexia Sarcopenia Muscle 2016; 7 (2): 126–135. doi: 10.1002/jcsm.12039.
11. Montano-Loza AJ, Meza-Junco J, Baracos VE et al. Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation. Liver Transplant 2014; 20 (6): 640–648. doi: 10.1002/lt.23863.
12. Kalafateli M, Mantzoukis K, Choi Yau Y et al. Malnutrition and sarcopenia predict post-liver transplantation outcomes independently of the Model for End-stage Liver Disease score. J Cachexia Sarcopenia Muscle 2017; 8 (1): 113–121. doi: 10.1002/jcsm.12095.
13. Masuda T, Shirabe K, Ikegami T et al. Sarcopenia is a prognostic factor in living donor liver transplantation. Liver Transpl 2014; 20 (4): 401–407. doi: 10.1002/lt.23811.
14. Englesbe MJ, Patel SP, He K et al. Sarcopenia and mortality after liver transplantation. J Am Coll Surg 2010; 211 (2): 271–278. doi: 10.1016/j.jamcollsurg.2010.03.039.
15. Kaido T, Ogawa K, Fujimoto Y et al. Impact of sarcopenia on survival in patients undergoing living donor liver transplantation. Am J Transplant 2013; 13 (6): 1549–1556. doi: 10.1111/ajt.12221.
16. Hamaguchi Y, Kaido T, Okumura S et al. Proposal for new selection criteria considering pre-transplant muscularity and visceral adiposity in living donor liver transplantation. J Cachexia Sarcopenia Muscle 2018; 9 (2): 246–254. doi: 10.1002/jcsm.12276.
17. Ebadi M, Tandon P, Moctezuma-Velazquez C et al. Low subcutaneous adiposity associates with higher mortality in female patients with cirrhosis. J Hepatol 2018; 69 (3): 608–616. doi: 10.1016/j.jhep.2018.04.015.
18. Kuo SZ, Ahmad M, Dunn MA et al. Sarcopenia predicts post-transplant mortality in acutely Ill men undergoing urgent evaluation and liver transplantation. Transplantation 2019; 103 (11): 2312–2317. doi: 10.1097/TP.000000000000 2741.
19. Lai JC, Sonnenday CJ, Tapper EB et al. Frailty in liver transplantation: an expert opinion statement from the American Society of Transplantation Liver and Intestinal Community of Practice. Am J Transplant 2019; 19 (7): 1896–1906. doi: 10.1111/ajt.15392.
20. Czigany Z, Kramp W, Lurje I et al. The role of recipient myosteatosis in graft and patient survival after deceased donor liver transplantation. J Cachexia Sarcopenia Muscle 2021; 12 (2): 358–367. doi: 10.1002/jcsm.12669.
21. Bhanji RA, Takahashi N, Moynagh MR et al. The evolution and impact of sarcopenia pre- and post-liver transplantation. Aliment Pharmacol Ther 2019; 49 (6): 807–813. doi: 10.1111/apt.15161.
22. Hamaguchi Y, Kaido T, Okumura S et al. Impact of quality as well as quantity of skeletal muscle on outcomes after liver transplantation. Liver Transpl 2014; 20 (11): 1413–1419. doi: 10.1002/lt.23970.
23. Krell RW, Kaul DR, Martin AR et al. Association between sarcopenia and the risk of serious infection among adults undergoing liver transplantation. Liver Transpl 2013; 19 (12): 1396–1402. doi: 10.1002/lt.23752.
24. Valero V 3rd, Amini N, Spolverato G et al. Sarcopenia adversely impacts postoperative complications following resection or transplantation in patients with primary liver tumors. J Gastrointest Surg 2015; 19 (2): 272–281. doi: 10.1007/s11605-014-2680-4.
25. Giusto M, Lattanzi B, Albanese C et al. Sarcopenia in liver cirrhosis: the role of computed tomography scan for the assessment of muscle mass compared with dual-energy X-ray absorptiometry and anthropometry. Eur J Gastroenterol Hepatol 2015; 27 (3): 328–334. doi: 10.1097/MEG.0000000000000274.
26. Bergerson JT, Lee JG, Furlan A et al. Liver transplantation arrests and reverses muscle wasting. Clin Transplant 2015; 29 (3): 216–221. doi: 10.1111/ctr.12506.
27. Wang CW, Feng S, Covinsky KE et al. A Comparison of Muscle Function, Mass, and Quality in Liver Transplant Candidates: Results From the Functional Assessment in Liver Transplantation Study. Transplantation 2016; 100 (8): 1692–1698. doi: 10.1097/TP.0000000000001 232.
28. Stretch C, Aubin JM, Mickiewicz B et al. Sarcopenia and myosteatosis are accompanied by distinct biological profiles in patients with pancreatic and periampullary adenocarcinomas. PLoS One 2018; 13 (5): e0196235. doi: 10.1371/journal.pone.0196235.
29. Ebadi M, Wang CW, Lai JC et al. Poor performance of psoas muscle index for identification of patients with higher waitlist mortality risk in cirrhosis. J Cachexia Sarcopenia Muscle 2018; 9 (6): 1053–1062. doi: 10.1002/jcsm.12349.
30. Meister FA, Bednarsch J, Amygdalos I et al. Various myosteatosis selection criteria and their value in the assessment of short- and long-term outcomes following liver transplantation. Sci Rep 2021; 11 (1): 13368. doi: 10.1038/ s41598-021-92798-5.
31. Shoreibah MG, Mahmoud K, Aboueldahab NA et al. Psoas muscle density in combination with model for end-stage liver disease score can improve survival predictability in transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol 2019; 30 (2): 154–161. doi: 10.1016/j.jvir.2018.10.006.
32. Qiu J, Thapaliya S, Runkana A et al. Hyperammonemia in cirrhosis induces transcriptional regulation of myostatin by an NF-kB-mediated mechanism. Proc Natl Acad Sci USA 2013; 110 (45): 18162–18167. doi: 10.1073/pnas.1317049 110.
33. Dasarathy S, Merli M. Sarcopenia from mechanism to diagnosis and treatment in liver disease. J Hepatol 2016; 65 (6): 1232–1244. doi: 10.1016/j.jhep.2016.07.040.
34. Chatauret N, Desjardins P, Zwingmann C et al. Direct molecular and spectroscopic evidence for increased ammonia removal capacity of skeletal muscle in acute liver failure. J Hepatol 2006; 44 (6): 1083–1088. doi: 10.1016/j.jhep.2005.11.048.
35. Nachit M, Leclercq IA. Emerging awareness on the importance of skeletal muscle in liver diseases: time to dig deeper into mechanisms! Clin Sci (Lond) 2019; 133 (3): 465–481. doi: 10.1042/CS20180421.
36. Stephens NA, Skipworth RJ, Macdonald AJ et al. Intramyocellular lipid droplets increase with progression of cachexia in cancer patients. J Cachexia Sarcopenia Muscle 2011; 2 (2): 111–117. doi: 10.1007/s13539-011-0030-x.
37. Gumucio JP, Qasawa AH, Ferrara PJ et al. Reduced mitochondrial lipid oxidation leads to fat accumulation in myosteatosis. FASEB J 2019; 33 (7): 7863–7881. doi: 10.1096/fj.201802457RR.