title: Association between sarcopenia and the risk of serious infection among adults undergoing liver transplantation.
abstract: Although sarcopenia (muscle loss) is associated with increased mortality after liver transplantation, its influence on other complications is less well understood. We examined the association between sarcopenia and the risk of severe posttransplant infections among adult liver transplant recipients. By calculating the total psoas area (TPA) on preoperative computed tomography scans, we assessed sarcopenia among 207 liver transplant recipients. The presence or absence of a severe posttransplant infection was determined by a review of the medical chart. The influence of posttransplant infections on overall survival was also assessed. We identified 196 episodes of severe infections among 111 patients. Fifty-six patients had more than 1 infection. The median time to the development of an infection was 27 days (interquartile range = 13-62 days). When the patients were grouped by TPA tertiles, patients in the lowest tertile had a greater than 4-fold higher chance of developing a severe infection in comparison with patients in the highest tertile (odds ratio = 4.6, 95% confidence interval =  2.25-9.53). In a multivariate analysis, recipient age (hazard ratio = 1.04, P = 0.02), pretransplant TPA (hazard ratio = 0.38, P < 0.01), and pretransplant total bilirubin level (hazard ratio = 1.05, P = 0.02) were independently associated with the risk of developing severe infections. Patients with severe posttransplant infections had worse 1-year survival than patients without infections (76% versus 92%, P = 0.003). In conclusion, among patients undergoing liver transplantation, a lower TPA was associated with a heightened risk for posttransplant infectious complications and mortality. Future efforts should focus on approaches for assessing and mitigating vulnerability in patients undergoing transplantation.
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Krell
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kaul
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Martin
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Englesbe
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sonnenday
authors.forename: Shijie
authors.initials: S
authors.lastname: Cai
authors.forename: Preeti N
authors.initials: PN
authors.lastname: Malani
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003141:Communicable Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D016658:Psoas Muscles / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012307:Risk Factors; D055948:Sarcopenia / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome