title: Impact of Skeletal Muscle Mass Index, Intramuscular Adipose Tissue Content, and Visceral to Subcutaneous Adipose Tissue Area Ratio on Early Mortality of Living Donor Liver Transplantation.
abstract: Skeletal muscle depletion has been shown to be an independent risk factor for poor survival in various diseases. However, in surgery, the significance of other body components including visceral and subcutaneous adipose tissue remains unclear.
  
  
  
  This retrospective study included 250 adult patients undergoing living donor liver transplantation (LDLT) between January 2008 and April 2015. Using preoperative plain computed tomography imaging at the third lumbar vertebra level, skeletal muscle mass, muscle quality, and visceral adiposity were evaluated by the skeletal muscle mass index (SMI), intramuscular adipose tissue content (IMAC), and visceral to subcutaneous adipose tissue area ratio (VSR), respectively. The cutoff values of these parameters were determined for men and women separately using the data of 657 healthy donors for LDLT between 2005 and 2016. Impact of these parameters on outcomes after LDLT was analyzed.
  
  
  
  VSR was significantly correlated with patient age (P = 0.041), neutrophil-lymphocyte ratio (P < 0.001), body mass index (P < 0.001), and SMI (P = 0.001). The overall survival probability was significantly lower in patients with low SMI (P < 0.001), high IMAC (P < 0.001), and high VSR (P < 0.001) than in each respective normal group. On multivariate analysis, low SMI (hazard ratio [HR], 2.367, P = 0.002), high IMAC (HR, 2.096, P = 0.004), and high VSR (HR, 2.213, P = 0.003) were identified as independent risk factors for death after LDLT.
  
  
  
  Preoperative visceral adiposity, as well as low muscularity, was closely involved with posttransplant mortality.
authors.affiliation: 1 Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Hamaguchi
authors.forename: Toshimi
authors.initials: T
authors.lastname: Kaido
authors.forename: Shinya
authors.initials: S
authors.lastname: Okumura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kobayashi
authors.forename: Hisaya
authors.initials: H
authors.lastname: Shirai
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yagi
authors.forename: Naoko
authors.initials: N
authors.lastname: Kamo
authors.forename: Hideaki
authors.initials: H
authors.lastname: Okajima
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D050154:Adiposity; D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006304:Health Status; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging / Q000503:physiopathology*; D007564:Japan; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055948:Sarcopenia / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016896:Treatment Outcome