title: Sarcopenia and failure to rescue following liver transplantation.
abstract: BACKGROUND
  Sarcopenic liver transplant recipients have higher rates of mortality, but mechanisms underlying these rates remain unclear. Failure to rescue (FTR) has been shown to be a primary driver of mortality following major general and vascular surgery. We hypothesized that FTR is common in sarcopenic liver transplant recipients.
  
  
  METHODS
  We retrospectively reviewed 348 liver transplant recipients with perioperative CT scans. Analytic morphomic techniques were used to assess trunk muscle size via total psoas area (TPA). One-yr major complication and FTR rates were calculated across TPA tertiles.
  
  
  RESULTS
  The one-yr complication rate was 77% and the FTR rate was 19%. Multivariate regression showed TPA as a significant predictor of FTR (OR = 0.27 per 1000 mm(2) increase in TPA, p < 0.001). Compared to patients in the largest muscle tertile, patients in the smallest tertile had 1.4-fold higher adjusted complication rates (91% vs. 66%) and 2.8-fold higher adjusted FTR rates (22% vs. 8%).
  
  
  CONCLUSIONS
  These results suggest that mortality in sarcopenic liver transplant recipients may be strongly related to FTR. Efforts aimed at early recognition and management of complications may decrease postoperative mortality. Additionally, this work highlights the need for expanded multicenter collaborations aimed at collection and analysis of postoperative complications in liver transplant recipients.
authors.affiliation: Morphomic Analysis Group, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Underwood
authors.affiliation: Morphomic Analysis Group, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: David C
authors.identifier: http://orcid.org/0000-0002-9488-6847
authors.initials: DC
authors.lastname: Cron
authors.affiliation: Morphomic Analysis Group, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Terjimanian
authors.affiliation: Morphomic Analysis Group, University of Michigan Medical School, Ann Arbor, MI, USA.|Department of Surgery, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Wang
authors.affiliation: Morphomic Analysis Group, University of Michigan Medical School, Ann Arbor, MI, USA.|Department of Surgery, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Englesbe
authors.affiliation: Department of Surgery, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Waits
mesh_terms: D000328:Adult; D058625:End Stage Liver Disease / Q000150:complications* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology*; D006085:Graft Survival; D017052:Hospital Mortality; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D055948:Sarcopenia / Q000175:diagnosis / Q000209:etiology*; D017211:Treatment Failure
keywords: complications; failure to rescue; frailty; liver transplantation; outcomes