Perioperative Changes in the Psoas Muscle Index in Patients Undergoing ABO-Incompatible Living-Donor Liver Transplantation: A Single-Center Experience

Abstract Introduction In the era of rituximab, ABO-incompatible living-donor liver transplantation (ABOi LDLT) is clinically accepted as a feasible therapy for end-stage liver disease. To date, no data on postoperative sarcopenic changes in patients undergoing ABOi LDLT are available. Patients and Methods Thirty-six adult patients undergoing ABOi LDLT between October 2010 and July 2017 at our hospital were retrospectively analyzed. The cross-sectional areas of both psoas muscles between the 3 rd and 4 th lumbar vertebrae were manually estimated from abdominal computed tomography images obtained within 1 month before surgery, and 1 and 3 weeks, 6 months, and 1 year after surgery. The mean psoas muscle areas were calculated and normalized by the height squared to create psoas muscle indices (PMIs). Results The PMIs on postoperative days (PODs) 7 and 21 were significantly lower than the preoperative PMI in each whole study and male cohort. In whole study cohort, the absolute and relative PMIs on POD 7 were 308.8 (271.5 – 375.8) mm 2 /m 2 and 95.3 (89.9 – 101.1) %. On POD 21, the values were 297.8 (258.5 – 349.6) mm 2 /m 2 and 90.7 (81.1 – 99.2) %. In males, they were 335.3 (276.7 – 389.4) mm 2 /m 2 and 94.2 (89.0 – 98.8) % on POD 7, and 305.0 (271.6 – 357.0) mm 2 /m 2 and 89.2 (83.2 – 98.2) % on POD 21. In females, they were 281.2 (231.1 – 313.7) mm 2 /m 2 and 101.4 (95.2 – 106.0) % on POD 7, and 260.7 (245.9 – 273.9) mm 2 /m 2 and 98.9 (77.9 – 124.3) % on POD 21. Conclusion ABOi LDLT patients were most vulnerable to core muscle loss soon after surgery.