INTRODUCTION: Sarcopenic liver transplant recipients have higher rates of mortality, but mechanisms underlying these rates remain unclear. Failure to rescue (FTR) has been shown to be a primary driver of mortality following major general and vascular surgery. We hypothesized that FTR is common in sarcopenic liver transplant recipients. METHODS: We retrospectively reviewed 348 liver transplant recipients with perioperative CT scans. Analytic morphomic techniques were used to assess trunk muscle size via total psoas area (TPA). One-yr major complication and FTR rates were calculated across TPA tertiles. RESULTS: The one-yr complication rate was 77% and the FTR rate was 19%. Multivariate regression showed TPA as a significant predictor of FTR (OR = 0.27 per 1000 mm(2) increase in TPA, p < 0.001). Compared to patients in the largest muscle tertile, patients in the smallest tertile had 1.4-fold higher adjusted complication rates (91% vs. 66%) and 2.8-fold higher adjusted FTR rates (22% vs. 8%). DISCUSSION: These results suggest that mortality in sarcopenic liver transplant recipients may be strongly related to FTR. Efforts aimed at early recognition and management of complications may decrease postoperative mortality. Additionally, this work highlights the need for expanded multicenter collaborations aimed at collection and analysis of postoperative complications in liver transplant recipients.
INTRODUCTION:Sarcopenic liver transplant recipients have higher rates of mortality, but mechanisms underlying these rates remain unclear. Failure to rescue (FTR) has been shown to be a primary driver of mortality following major general and vascular surgery. We hypothesized that FTR is common in sarcopenic liver transplant recipients. METHODS: We retrospectively reviewed 348 liver transplant recipients with perioperative CT scans. Analytic morphomic techniques were used to assess trunk muscle size via total psoas area (TPA). One-yr major complication and FTR rates were calculated across TPA tertiles. RESULTS: The one-yr complication rate was 77% and the FTR rate was 19%. Multivariate regression showed TPA as a significant predictor of FTR (OR = 0.27 per 1000 mm(2) increase in TPA, p < 0.001). Compared to patients in the largest muscle tertile, patients in the smallest tertile had 1.4-fold higher adjusted complication rates (91% vs. 66%) and 2.8-fold higher adjusted FTR rates (22% vs. 8%). DISCUSSION: These results suggest that mortality in sarcopenic liver transplant recipients may be strongly related to FTR. Efforts aimed at early recognition and management of complications may decrease postoperative mortality. Additionally, this work highlights the need for expanded multicenter collaborations aimed at collection and analysis of postoperative complications in liver transplant recipients.
Authors: Estella M Alonso; Wen Ye; Kieran Hawthorne; Veena Venkat; Kathleen M Loomes; Cara L Mack; Paula M Hertel; Saul J Karpen; Nanda Kerkar; Jean P Molleston; Karen F Murray; Rene Romero; Philip Rosenthal; Kathleen B Schwarz; Benjamin L Shneider; Frederick J Suchy; Yumirle P Turmelle; Kasper S Wang; Averell H Sherker; Ronald J Sokol; Jorge A Bezerra; John C Magee Journal: J Pediatr Date: 2018-09-21 Impact factor: 4.406
Authors: William H Jin; Eric A Mellon; Jessica M Frakes; Gilbert Z Murimwa; Pamela J Hodul; Jose M Pimiento; Mokenge P Malafa; Sarah E Hoffe Journal: J Gastrointest Oncol Date: 2018-02
Authors: Hani Oweira; Mahmoud Sadeghi; Daniel Volker; Markus Mieth; Ahmed Zidan; Elias Khajeh; Omid Ghamarnejad; Hamidreza Fonouni; Karl Heinz Weiss; Jan Schmidt; Imad Lahdou; Arianeb Mehrabi Journal: Ann Transplant Date: 2018-06-08 Impact factor: 1.530
Authors: Nicholas C Wang; Peng Zhang; Elliot B Tapper; Sameer Saini; Stewart C Wang; Grace L Su Journal: Am J Gastroenterol Date: 2020-08 Impact factor: 12.045
Authors: Cornelius Engelmann; Karen Louise Thomsen; Nekisa Zakeri; Mohammed Sheikh; Banwari Agarwal; Rajiv Jalan; Rajeshwar P Mookerjee Journal: Crit Care Date: 2018-10-10 Impact factor: 9.097