Introduction Objective measures are needed to assess risk of perioperative morbidity in patients undergoing liver transplant (LT). Studies have shown sarcopenia, as measured by total psoas area (TPA), to predict poor short-term outcomes following surgery. There is debate as to the best way of measuring sarcopenia in clinical practice. The aims of this study were to assess sarcopenia as a predictor of outcome following primary elective liver transplant (PELT) and to determine whether grip strength can be used to measure sarcopenia in the clinical setting.
Method We performed a retrospective review of successive patients undergoing PELT at our institution between Aug 2014 and Aug 2016.Patient demographics, transplant indication, MELD, UKELD, Donor specific Risk Index, anaerobic threshold (AT) measured by cardiopulmonary exercise testing (CPET) and anthropometry data were recorded, as well as length of hospital stay, ICU stay and ventilator support, and septic complications. TPA at the level of L3 was measured on peri-operative CT/MRI scans. Spearman’s correlation co-efficient was used to assess the association between TPA, gripstrength, AT and outcome measures.
Results 87 patients underwent LT during the study period, 65 of which were for PELT (50.8% female; 56.3±11.6 years). 52/65 (80%) had scans pre- or up to 30 days post-liver transplant. Mean TPA was 4.22 cm2/m2. 15/52, (71%) were sarcopenic (TPA <5 cm2/m2 ). Median length of hospital and ICU stay were 23 and 4 days respectively. Grip strength correlated with TPA (r=0.946 p<0.0001) and AT by CPET (r=0.339 p=0.028). There was no significant relationship between TPA and length of hospital stay (p=0.164) or ITU stay (p=0.356). Low AT was significantly associated with prolonged length of hospital stay (p=0.018). Grip strength showed a trend towards a negative correlation with length of ITU stay (p=0.056).
Conclusion Our study suggests that grip strength is a valid measure of sarcopenia in patients undergoing LT. In our cohort, we did not find a significant association between sarcopenia (as measured by total psoas area) and poor short-term post-operative outcomes. Anaerobic threshold by CPET may provide a better global assessment of patients’ fitness for LT than pure muscle mass. Together, CPET and grip-strength provide a simple, low cost, effective way of assessing fitness for liver transplant. Further study is required to validate these findings and to assess whether prehabilitation to improve these parameters can accelerate patient recovery and improve outcomes in liver transplantation.
. Cooper C, et al. Tools in the Assessment of Sarcopenia.Calcified tissue international 2013;93(3):201–210. PMC. Web. 14 Feb. 2017.
Disclosure of Interest None Declared
- grip strength
- liver transplant