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Kömürkara S, Cengiz Z, Tok S. Assessing Frailty, Rational Use of Medications, and Adherence to Immunosuppressive Therapy in Liver Transplant Recipients. Transplant Proc 2024:S0041-1345(24)00470-6. [PMID: 39244449 DOI: 10.1016/j.transproceed.2024.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 08/24/2024] [Indexed: 09/09/2024]
Abstract
AIM The study was conducted to determine the level of frailty, rational medication use, and adherence to immunosuppressive therapy in liver transplant patients and to examine the relationships among them. MATERIALS AND METHODS The data of the descriptive cross-sectional study were collected between January 2023 and September 2023. Our study included 200 liver transplant recipients. In addition to demographic and medical characteristics, frailty status, rational drug use, and compliance with immunosuppressive therapy were measured in a 15-20 minute questionnaire administration period. RESULTS The frailty scores of liver transplant patients were 2.11 ± 1.34, rational drug use scores were 82.88 ± 13.11, and compliance with immunosuppressive therapy scores were 11.12 ± 1.07. The scores for rational drug use and adherence to immunosuppressive therapy were not affected by frailty status, and patients used drugs rationally and adhered to immunosuppressive therapy even when they were frail. It was found that the vulnerability status of the participants was affected by gender and occupational variables, most patients were in the vulnerable group in women and men, and those who did not work were more vulnerable than the other groups. CONCLUSION It was found that liver transplant patients were frail, and frailty did not affect the level of rational drug use and compliance with immunosuppressive therapy.
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Affiliation(s)
| | - Zeliha Cengiz
- Department of Fundamentals of Nursing, Inonu University, Nursing Faculty, Malatya, Turkey.
| | - Sedef Tok
- Malatya Training and Research Hospital, Malatya, Turkey.
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Ferreira SC, Cardoso ADSR, Machado ADAS, Anastácio LR. Effect of a 12-week nutritional intervention in the food intake of patients on the waiting list for liver transplantation: A secondary analysis of a randomized controlled trial. Clin Nutr 2024; 43:1278-1290. [PMID: 38663049 DOI: 10.1016/j.clnu.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/28/2024] [Accepted: 03/25/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Inadequate food intake contributes to malnutrition in patients with cirrhosis on the waiting list for liver transplantation (LTx). OBJECTIVE To evaluate food intake during 12 weeks of nutritional follow-up and assess factors independently associated with the difference between energy and protein intake in LTx patients. METHODS A secondary analysis of data from a randomized controlled trial that evaluated the effects of Beta-Hydroxy-Beta-Methylbutyrate (HMB) supplementation and nutritional intervention in patients on a liver transplant waiting list. Dietary guidelines for patients with cirrhosis were used to prescribe the nutritional plan (35 kcal/kg; 1.5 g/kg dry weight for protein) and to evaluate the nutritional goals (30 kcal/kg; 1.2 g/kg dry weight for protein; late evening snack) and nutritional counseling dietary follow-ups were performed in each evaluation. Food intake was assessed in six moments: Baseline, week 0 (W0), week 2 (W2), week 4 (W4), week 8 (W8), and week 12 (W12). RESULTS Forty-seven patients (55.0 ± 10.6y; 72.3% male) were evaluated. Only 25.5% (n = 12) of patients achieved nutritional goals at the end of the study. The mean energy intake at Baseline was 1782 ± 784 kcal (27.6 ± 13.2 kcal/kg) without difference between moments. The protein intake increased between W0 [63.4 ± 29.8g; 0.8(0.2-2.2 g/kg)] and W8 [72.0 ± 28.0g; 1.0(0.4-2.6 g/kg); p = 0.03; p = 0.03, respectively]. The consumption of cholesterol, calcium, phosphorus, magnesium, iron, and niacin increased (p < 0.05), as well as the consumption of legumes; roots and tubers; dairy; and meat, poultry and fish groups through time (p < 0.05). The percentage of patients that consumed a late evening snack rised from 40.4% (Baseline) to 76.6% (W8) (p < 0.001). The presence of ascites, nourished patients, frailty index classification, short physical performance battery score, systemic symptoms, and emotional function in the Quality of Life Test were independently associated with the energy intake difference between W12 and Baseline (p < 0.05). Diabetes mellitus, patients with moderately malnourishment, poor performance, fatigue, systemic symptoms, and emotional function in the Quality of Life Test were independently associated with the difference in protein intake between W12 and Baseline (p < 0.05). CONCLUSION Patients on the liver transplant waiting list showed slight food intake improvement during the follow-up, but few met nutritional guidelines. Various clinical and nutritional factors independently affected energy and protein intake from W12 to Baseline.
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Affiliation(s)
| | | | | | - Lucilene Rezende Anastácio
- Food Science Department, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Choudhury A, Adali G, Kaewdech A, Giri S, Kumar R. Liver Transplantation in Chronic Liver Disease and Acute on Chronic Liver Failure- Indication, Timing and Practices. J Clin Exp Hepatol 2024; 14:101347. [PMID: 38371606 PMCID: PMC10869905 DOI: 10.1016/j.jceh.2024.101347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
Liver transplantation (LT) is the second most common solid organ transplantation worldwide. LT is considered the best and most definitive therapeutic option for patients with decompensated chronic liver disease (CLD), hepatocellular carcinoma (HCC), acute liver failure (ALF), and acute-on-chronic liver failure (ACLF). The etiology of CLD shows wide geographical variation, with viral hepatitis being the major etiology in the east and alcohol-related liver disease (ALD) in the west. Non-alcoholic fatty liver disease (NAFLD) is on an increasing trend and is expected to be the most common etiology on a global scale. Since the first successful LT, there have been radical changes in the indications for LT. In many circumstances, not just the liver disease itself but factors such as extra-hepatic organ dysfunction or failures necessitate LT. ACLF is a dynamic syndrome that has extremely high short-term mortality. Currently, there is no single approved therapy for ACLF, and LT seems to be the only feasible therapeutic option for selected patients at high risk of mortality. Early identification of ACLF, stratification of patients according to disease severity, aggressive organ support, and etiology-specific treatment approaches have a significant impact on post-transplant outcomes. This review briefly describes the indications, timing, and referral practices for LT in patients with CLD and ACLF.
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Affiliation(s)
- Ashok Choudhury
- Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Gupse Adali
- Department of Gastroenterology and Hepatology, University of Health Sciences, Ümraniye, İstanbul, Turkey
| | - Apichat Kaewdech
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Suprabhat Giri
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneshwar, India
| | - Rahul Kumar
- Duke-NUS Academic Medical Centre, Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
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Müller M, Grasshoff C. [The Role of the Anaesthesiologist in Liver Transplantation - Preoperative Evaluation]. Anasthesiol Intensivmed Notfallmed Schmerzther 2024; 59:283-295. [PMID: 38759684 DOI: 10.1055/a-2152-7350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Preoperative evaluation prior to listing for orthotopic liver transplantation (LT) requires a careful multidisciplinary approach with specialized teams including surgeons, hepatologists and anesthesiologists in order to improve short- and long-term clinical outcomes. Due to inadequate supply of donor organs and changing demographics, patients listed for LT have become older, sicker and share more comorbidities. As cardiovascular events are the leading cause for early mortality precise evaluation of risk factors is mandatory. This review focuses on the detection and management of coronary artery disease, cirrhotic cardiomyopathy, portopulmonary hypertension and hepatopulmonary syndrome in patients awaiting LT. Further insights are being given into scoring systems, patients with Acute-on-chronic-liver-failure (ACLF), frailty, NASH cirrhosis and into psychologic evaluation of patients with substance abuse.
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Manfready RA, Rzepczynski A, Janardhan SV. Which patient should be prioritized for liver transplant: NAFLD? Clin Liver Dis (Hoboken) 2024; 23:e0163. [PMID: 38860126 PMCID: PMC11164004 DOI: 10.1097/cld.0000000000000163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/27/2024] [Indexed: 06/12/2024] Open
Affiliation(s)
- Richard A. Manfready
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Allison Rzepczynski
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Sujit V. Janardhan
- Department of Internal Medicine, Section of Hepatology, Rush University Medical Center, Chicago, Illinois, USA
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Trigui A, Rose CF, Bémeur C. Nutritional Strategies to Manage Malnutrition and Sarcopenia following Liver Transplantation: A Narrative Review. Nutrients 2023; 15:nu15040903. [PMID: 36839261 PMCID: PMC9965211 DOI: 10.3390/nu15040903] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
Persisting or newly developed malnutrition and sarcopenia after liver transplant (LT) are correlated with adverse health outcomes. This narrative review aims to examine the literature regarding nutrition strategies to manage malnutrition and sarcopenia after LT. The secondary aims are to provide an overview of the effect of nutrition strategies on the incidence of infections, hospital length of stay (LOS), acute cellular rejection (ACR), and mortality after LT. Four databases were searched. A total of 25 studies, mostly of mid-high quality, were included. Six studies found a beneficial effect on nutritional parameters using branched-chain amino acids (BCAA), immunomodulating diet (IMD), or enteral nutrition (EN) whereas two studies using beta-hydroxy-beta-methylbutyrate (HMB) found a beneficial effect on muscle mass and function. Fourteen studies using pre- or pro-biotics, IMD, and EN were effective in lowering infection and six studies using IMD, BCAA or HMB reported reduced hospital LOS. Finally, four studies using HMB and vitamin D were effective in reducing ACR and one study reported reduced mortality using vitamin D after LT. In conclusion, nutritional intervention after LT has different beneficial effects on malnutrition, sarcopenia, and other advert outcomes. Additional large and well-constructed RCTs using validated tools to assess nutritional status and sarcopenia are warranted to ensure more robust conclusions.
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Affiliation(s)
- Amal Trigui
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1A8, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
| | - Christopher F. Rose
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Chantal Bémeur
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1A8, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada
- Correspondence: ; Tel.: +1-5148908000 (ext. 23607)
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Warner II ER, Satapathy SK. Sarcopenia in the Cirrhotic Patient: Current Knowledge and Future Directions. J Clin Exp Hepatol 2023; 13:162-177. [PMID: 36647414 PMCID: PMC9840086 DOI: 10.1016/j.jceh.2022.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 06/13/2022] [Indexed: 02/07/2023] Open
Abstract
Cirrhosis predisposes to abnormalities in energy, hormonal, and immunological homeostasis. Disturbances in these metabolic processes create susceptibility to sarcopenia or pathological muscle wasting. Sarcopenia is prevalent in cirrhosis and its presence portends significant adverse outcomes including the length of hospital stay, infectious complications, and mortality. This highlights the importance of identification of at-risk individuals with early nutritional, therapeutic and physical therapy intervention. This manuscript summarizes literature relevant to sarcopenia in cirrhosis, describes current knowledge, and elucidates possible future directions.
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Key Words
- ACE, angiotensin-converting enzyme
- ACE-I, angiotensin-converting enzyme inhibitor
- AKI, acute kidney injury
- ALM, appendicular lean mass
- ARB, angiotensin receptor blocker
- ASM, appendicular skeletal mass
- AT1R, angiotensin type 1 receptor
- AT2R, angiotensin type 2 receptor
- ATP, adenosine-5′-triphosphate
- AWGS, Asian Working Group for Sarcopenia
- BCAA, branched chained amino acids
- BIA, bioelectrical impedance analysis
- BMI, body mass index
- CART, classification and regression tree
- CKD, chronic kidney disease
- CRP, C-reactive protein
- DEXA, dual energy X-ray absorptiometry
- EAA, essential amino acids
- ESPEN-SIG, European Society for Clinical Nutrition and Metabolism Special Interests Groups
- ESRD, end-stage renal disease
- EWGSOP, European Working Group on Sarcopenia in Older People
- FAD, flavin adenine dinucleotide
- FADH2, flavin adenine dinucleotide +2 hydrogen
- FNIH, Foundation for the National Institutes of Health
- GTP, guanosine-5′-triphosphate
- GnRH, gonadotrophin-releasing hormone
- HCC, hepatocellular carcinoma
- HPT, hypothalamic-pituitary-testicular
- IFN-γ, interferon γ
- IGF-1, insulin-like growth factor 1
- IL-1, interleukin-1
- IL-6, interleukin-6
- IWGS, International Working Group on Sarcopenia
- LH, luteinizing hormone
- MELD, Model for End-Stage Liver Disease
- MuRF1, muscle RING-finger-1
- NAD, nicotinamide adenine dinucleotide
- NADH, nicotinamide adenine dinucleotide + hydrogen
- NADPH, nicotinamide adenine dinucleotide phosphate
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- NF-κβ, nuclear factor κβ
- NHANES, National Health and Nutritional Examination Survey
- PMI, psoas muscle index
- PMTH, psoas muscle thickness
- RAAS, renin-angiotensin-aldosterone system
- ROS, reactive oxygen species
- SARC-F, Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls
- SHBG, sex hormone binding globulin
- SMI, skeletal muscle index
- SNS, sympathetic nervous system
- SPPB, Short Performance Physical Battery
- TNF-α, tumor necrosis factor α
- UCSF, University of California, San Francisco
- UNOS, United Network of Organ Sharing
- cirrhosis
- energy
- mTOR, mammalian target of rapamycin
- metabolism
- muscle
- sarcopenia
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Affiliation(s)
- Edgewood R. Warner II
- Department of Medicine, Donald and Barbara Zucker School of Medicine/Northwell Health, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Sanjaya K. Satapathy
- Division of Hepatology and Northwell Health Center for Liver Diseases and Transplantation, Department of Medicine, Donald and Barbara Zucker School of Medicine/Northwell Health, 300 Community Drive, Manhasset, NY, 11030, USA
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Choi C, Simonetto DA. Digital interventions in the management of advanced liver disease: Prescription and monitoring of healthy living in homes. Clin Liver Dis (Hoboken) 2022; 20:162-165. [PMID: 36447901 PMCID: PMC9700047 DOI: 10.1002/cld.1253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/27/2022] Open
Abstract
Content available: Audio Recording.
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Affiliation(s)
- Chansong Choi
- Department of Internal MedicineMayo ClinicMinnesotaRochesterUSA
| | - Douglas A. Simonetto
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineMayo ClinicMinnesotaRochesterUSA
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Editorial commentary on the Indian Journal of Gastroenterology -September-October 2022. Indian J Gastroenterol 2022; 41:419-423. [PMID: 36131069 DOI: 10.1007/s12664-022-01297-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Kornberg A, Kaschny L, Kornberg J, Friess H. Preoperative Prognostic Nutritional Index May Be a Strong Predictor of Hepatocellular Carcinoma Recurrence Following Liver Transplantation. J Hepatocell Carcinoma 2022; 9:649-660. [PMID: 35923612 PMCID: PMC9342250 DOI: 10.2147/jhc.s366107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/23/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose Malnutrition is a major risk factor of immune dysfunction and poor outcome in cancer patients. The prognostic nutritional index (PNI), which is established by serum albumin level and peripheral lymphocyte count, was shown to correlate with prognosis of hepatocellular carcinoma (HCC) patients following liver resection and non-surgical interventions. The aim of this study was to analyze the predictive value of preoperative PNI in liver transplantation (LT) patients with HCC. Patients and Methods A total of 123 HCC patients that underwent LT were included in the analysis. The prognostic impact of preoperatively assessed clinical factors including the PNI on post-LT outcome was analyzed by uni- and multivariate analysis. Results Post-transplant tumor recurrence rates were 5.1% in high-PNI (> 42) and 55.6% in low-PNI (≤ 42) patients (p < 0.001). Preoperative high-PNI could be identified as a significant and independent promoter of both recurrence-free survival (hazard ratio [HR] = 10.12, 95% CI: 3.40–30.10; p < 0.001) and overall survival (HR = 1.69, 95% CI: 1.02–2.79; p = 0.004) following LT. Apart from that low-PNI proved to be a significant and independent predictor of microvascular tumor invasion (OR = 7.71, 95% CI: 3.17–18.76; p < 0.001). In contrast, no tumor morphology features including the Milan criteria revealed an independent prognostic value. Conclusion Our data indicate that preoperative PNI correlates with biological tumor aggressiveness and outcome following LT in HCC patients and may therefore be useful for refining oncologic risk stratification.
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Affiliation(s)
- Arno Kornberg
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
- Correspondence: Arno Kornberg, Technical University of Munich, Medical School, Klinikum rechts der Isar, Department of Surgery, Ismaningerstr. 22, Munich, D-81675, Germany, Tel +49 89 41405087, Fax +49 89 41404884, Email
| | - Linda Kaschny
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Jennifer Kornberg
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Helmut Friess
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
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Veraldi S, Pietrobattista A, Soglia G, Monti L, Alterio T, Mosca A, Liccardo D, Basso MS, Della Corte C, Russo L, Candusso M, Chiusolo F, Tortora F, Spada M, Maggiore G. Sarcopenia in children with chronic liver disease: Prevalence and impact on liver transplant outcomes. Front Pediatr 2022; 10:1033570. [PMID: 36741094 PMCID: PMC9891232 DOI: 10.3389/fped.2022.1033570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
Sarcopenia is a clinical condition characterized by a reduction in muscle mass, which typically affects adult patients; however, it has recently been recognized in pediatric literature. Few studies in children with chronic liver disease (CLD) undergoing liver transplantation (LT) have investigated the role of sarcopenia, with controversial results. The aim of our study was to assess the prevalence and impact of sarcopenia among children with CLD who are candidates for LT. We conducted a retrospective, single-center study at Bambino Gesù Children's Hospital (Rome, Italy) from July 2016 to July 2021, evaluating all children (0-16 years old) with CLD listed for LT with an abdomen computed tomography imaging available before LT. The total psoas muscle surface area (t-PMSA) was defined as the sum of left and right psoas muscle surface area measured at L4-L5 on axial images. The t-PMSA z-score was calculated according to reference data, and sarcopenia was defined as a t-PMSA z-score of ≤-2 (1-16 years) or a psoas muscle index [PMI; PMI = t-PMSA/(100 × BSA)] of <50th percentile of the population examined (<1 year). Clinical, laboratory, and LT outcome data were collected from all the patients with CLD. 27 out 48 (56%) of the patients aged 1-16 years were sarcopenic. No differences were noted in anthropometrics, nutritional support, liver function tests, model for ESLD (MELD), or pediatric ESLD (PELD) scores between patients with and without sarcopenia. The former showed a higher prevalence of respiratory complications (66.7% vs. 42.1%) and need for inotropes (40.7% vs. 10.8%) after LT. Among patients aged 0-1 years (n: 36), those with reduced muscle mass (50%) had a longer hospitalization time (44 vs. 24 days) and higher incidences of multi-organ failure syndrome (38.9% vs. 0%) and intensive care unit-related infections (61.1% vs. 27.8%) compared to those with greater muscle mass. t-PMSA and PMI were statistically significant predictors of LT outcomes. Sarcopenia is a reliable index of frailty in children with CLD, as its presence is associated with the risk of a more challenging LT. Future studies will have to investigate the functional aspects of sarcopenia and conceive preventive measures of muscle wasting in CLD patients.
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Affiliation(s)
- Silvio Veraldi
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.,Department of Anatomical, Histological, Forensic and Locomotor Apparatus Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Pietrobattista
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Giovanna Soglia
- Department of Radiology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Lidia Monti
- Department of Radiology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Tommaso Alterio
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Antonella Mosca
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Daniela Liccardo
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Maria Sole Basso
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Claudia Della Corte
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Luca Russo
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCSS, Rome, Italy
| | - Manila Candusso
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Fabrizio Chiusolo
- Anesthesia and Critical Care Medicine, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Francesca Tortora
- Anesthesia and Critical Care Medicine, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Marco Spada
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Giuseppe Maggiore
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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