Is there any correlation between liver graft regeneration and recipient’s pretransplant skeletal muscle mass?—A study in extended left lobe graft living-donor liver transplantation

Riccardo Pravisani, Akihiko Soyama, Shinichiro Ono, Umberto Baccarani, Miriam Isola, Mitsuhisa Takatsuki, Masaaki Hidaka, Tomohiko Adachi, Takanobu Hara, Takashi Hamada, Florian Pecquenard, Andrea Risaliti, Susumu Eguchi

Abstract

Background: The end-stage liver disease causes a metabolic dysfunction whose most prominent clinical feature is the loss of skeletal muscle mass (SMM). In living-donor liver transplantation (LDLT), liver graft regeneration (GR) represents a crucial process to normalize the portal hypertension and to meet the metabolic demand of the recipient. Limited data are available on the correlation between pre-LDLT low SMM and GR.
Methods: Retrospective study on a cohort of 106 LDLT patients receiving an extended left liver lobe graft. The skeletal muscle index (SMI) at L3 level was used for muscle mass measurement, and the recommended cut-off values of the Japanese Society of Hepatology guidelines were used as criteria for defining low muscularity. GR was evaluated as rate of volume increase at 1 month post-LT [graft regeneration rate (GRR)].
Results: The median GRR at 1 month post-LT was 91% (IQR, 65–128%) and a significant correlation with graft volume-to-recipient standard liver volume ratio (GV/SLV) (rho −0.467, P<0.001), graft-to- recipient weight ratio (GRWR) (rho −0.414, P<0.001), donor age (rho −0.306, P=0.001), 1 month post-LT cholinesterase serum levels (rho 0.397, P=0.002) and pre-LT low muscularity [absent vs. present GRR 97.5% (73.1–130%) vs. 83.5% (45.2–110.9%), P=0.041] was noted. Moreover in male recipients, but not in women, it was shown a direct correlation with pre-LT SMI (rho 0.352, P=0.020) and inverse correlation with 1 month post-LT SMI variation (rho −0.301, P=0.049). A low GRR was identified as an independent prognostic factor for recipient overall survival (HR 6.045, P<0.001).
Conclusions: Additionally to the hemodynamic factors of portal circulation and the quality of the graft, the metabolic status of the recipients has a significant role in the GR process. A pre-LT low SMM is associated with impaired GRR and this negative impact is more evident in male recipients.

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