Post-liver transplantation sarcopenia in cirrhosis: a prospective evaluation.
OBJECTIVE
Pre-transplant sarcopenia (reduced skeletal muscle mass) predicts poor outcome in cirrhosis. In contrast, whether muscle mass increases post-orthotopic liver transplantation (OLT) is not known and was studied prospectively.


METHODS
Consecutive patients who underwent a comprehensive nutritional evaluation in a liver transplant nutrition clinic were included. Core abdominal muscle area was measured on abdominal computed tomography obtained pre- and post-OLT. Age- and gender-based controls were used to define sarcopenia. Measures of body composition pre-transplant were correlated with computed tomography measurements. Predictors and clinical impact of post-OLT change in muscle area were examined. In three subjects post-OLT and three controls, expression of genes regulating skeletal muscle mass were quantified.


RESULTS
During the study period, 53 patients (M:F 41:12; age 56.9 ± 7.5 years) were followed up after OLT for 19.3 ± 9 months. Five patients died and another five had acute graft rejection. Pre-OLT sarcopenia was present in 33 (66.2%). Pre-transplant clinical characteristics including Child's score, MELD score, and nutritional status or post-transplantation immunosuppression regimen did not predict post-transplant change in muscle mass. New onset post-OLT sarcopenia developed in 14 patients. Loss of muscle mass post-OLT increased risk of diabetes mellitus and a trend toward higher mortality. Skeletal muscle expression of myostatin was higher and that of ubiquitin proteasome proteolytic components lower post-OLT than in controls.


CONCLUSIONS
Post-transplantation sarcopenia is common and could not be attributed to pre-transplant characteristics or the type or duration of post-OLT immunosuppression. Post-transplant sarcopenia contributes to adverse consequences and strategies targeting myostatin may be beneficial.
Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
Cynthia
C
Tsien
Ari
A
Garber
Arvind
A
Narayanan
Shetal N
SN
Shah
David
D
Barnes
Bijan
B
Eghtesad
John
J
Fung
Arthur J
AJ
McCullough
Srinivasan
S
Dasarathy
D000328:Adult; D000368:Aged; D001823:Body Composition; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D055948:Sarcopenia / Q000150:complications*; D013997:Time Factors
cirrhosis; liver transplantation; outcome; sarcopenia