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Association between sarcopenia and the risk of serious infection among adults undergoing liver transplantation
Author(s) -
Krell Robert W.,
Kaul Daniel R.,
Martin Andrew R.,
Englesbe Michael J.,
Sonnenday Christopher J.,
Cai Shijie,
Malani Preeti N.
Publication year - 2013
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.23752
Subject(s) - medicine , sarcopenia , interquartile range , hazard ratio , liver transplantation , odds ratio , confidence interval , transplantation , gastroenterology , surgery
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. Liver Transpl 19:1396–1402, 2013 . © 2013 AASLD.