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Post‐liver transplantation sarcopenia in cirrhosis: A prospective evaluation
Author(s) -
Tsien Cynthia,
Garber Ari,
Narayanan Arvind,
Shah Shetal N,
Barnes David,
Eghtesad Bijan,
Fung John,
McCullough Arthur J,
Dasarathy Srinivasan
Publication year - 2014
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12524
Subject(s) - sarcopenia , medicine , cirrhosis , liver transplantation , transplantation , immunosuppression , gastroenterology , skeletal muscle , prospective cohort study , diabetes mellitus , surgery , endocrinology
Background and Aim 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 C hild'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.