BACKGROUND: Skeletal muscle depletion has been shown to be an independent risk factor for poor survival in various diseases. However, in surgery, the significance of other body components including visceral and subcutaneous adipose tissue remains unclear. METHODS: This retrospective study included 250 adult patients undergoing living donor liver transplantation (LDLT) between January 2008 and April 2015. Using preoperative plain computed tomography imaging at the third lumbar vertebra level, skeletal muscle mass, muscle quality, and visceral adiposity were evaluated by the skeletal muscle mass index (SMI), intramuscular adipose tissue content (IMAC), and visceral to subcutaneous adipose tissue area ratio (VSR), respectively. The cutoff values of these parameters were determined for men and women separately using the data of 657 healthy donors for LDLT between 2005 and 2016. Impact of these parameters on outcomes after LDLT was analyzed. RESULTS: VSR was significantly correlated with patient age (P = 0.041), neutrophil-lymphocyte ratio (P < 0.001), body mass index (P < 0.001), and SMI (P = 0.001). The overall survival probability was significantly lower in patients with low SMI (P < 0.001), high IMAC (P < 0.001), and high VSR (P < 0.001) than in each respective normal group. On multivariate analysis, low SMI (hazard ratio [HR], 2.367, P = 0.002), high IMAC (HR, 2.096, P = 0.004), and high VSR (HR, 2.213, P = 0.003) were identified as independent risk factors for death after LDLT. CONCLUSIONS: Preoperative visceral adiposity, as well as low muscularity, was closely involved with posttransplant mortality.
BACKGROUND: Skeletal muscle depletion has been shown to be an independent risk factor for poor survival in various diseases. However, in surgery, the significance of other body components including visceral and subcutaneous adipose tissue remains unclear. METHODS: This retrospective study included 250 adult patients undergoing living donor liver transplantation (LDLT) between January 2008 and April 2015. Using preoperative plain computed tomography imaging at the third lumbar vertebra level, skeletal muscle mass, muscle quality, and visceral adiposity were evaluated by the skeletal muscle mass index (SMI), intramuscular adipose tissue content (IMAC), and visceral to subcutaneous adipose tissue area ratio (VSR), respectively. The cutoff values of these parameters were determined for men and women separately using the data of 657 healthy donors for LDLT between 2005 and 2016. Impact of these parameters on outcomes after LDLT was analyzed. RESULTS: VSR was significantly correlated with patient age (P = 0.041), neutrophil-lymphocyte ratio (P < 0.001), body mass index (P < 0.001), and SMI (P = 0.001). The overall survival probability was significantly lower in patients with low SMI (P < 0.001), high IMAC (P < 0.001), and high VSR (P < 0.001) than in each respective normal group. On multivariate analysis, low SMI (hazard ratio [HR], 2.367, P = 0.002), high IMAC (HR, 2.096, P = 0.004), and high VSR (HR, 2.213, P = 0.003) were identified as independent risk factors for death after LDLT. CONCLUSIONS: Preoperative visceral adiposity, as well as low muscularity, was closely involved with posttransplant mortality.
Authors: Michaela R Anderson; Jayaram K Udupa; Ethan Edwin; Joshua M Diamond; Jonathan P Singer; Jasleen Kukreja; Steven R Hays; John R Greenland; Anthony Ferrante; Matthew Lippel; Tatiana Blue; Amika McBurnie; Michelle Oyster; Laurel Kalman; Melanie Rushefski; Caiyun Wu; Gargi Pednekar; Wen Liu; Selim Arcasoy; Joshua Sonett; Frank D'Ovidio; Matthew Bacchetta; John D Newell; Drew Torigian; Edward Cantu; Donna L Farber; Jon T Giles; Yubing Tong; Scott Palmer; Lorraine B Ware; Wayne W Hancock; Jason D Christie; David J Lederer Journal: J Heart Lung Transplant Date: 2019-08-10 Impact factor: 10.247
Authors: Michaela R Anderson; Imaani Easthausen; Grace Gallagher; Jayaram Udupa; Yubing Tong; Drew Torigian; Joshua Matthew Diamond; Mary Katherine Porteous; Scott M Palmer; Laurie D Snyder; Luke Benvenuto; Meghan Aversa; Selim Arcasoy; John R Greenland; Steven R Hays; Jasleen Kukreja; Edward Cantu; John Shinn Kim; Dympna Gallagher; Matthew R Baldwin; R Graham Barr; David J Lederer; Jason D Christie; Jonathan Paul Singer Journal: Thorax Date: 2020-06-01 Impact factor: 9.139