Associations Of Sarcopenia And Its Evaluation Index With Postoperative Adverse Events In Patients With Liver Transplantation

Objective:(1)To analyze the association between sarcopenia and adverse events after liver transplantation.(2)To assess whether sarcopenia index can influence the occurrence of postoperative adverse events in patients with liver transplantation.Methods:This study retrospectively studied patients who underwent classic orthotopic liver transplantation in our hospital from August 2017 to September2020,and selected 161 patients who met the research conditions,and then counted sarcopenia indexes such as skeletal muscle index and other indicators,including: age,gender,height,weight,body mass index(BMI),primary cause,Meld score,Child-Pugh classification,whether there is ascites before liver transplantation,skeletal muscle area(SMA),psoas muscle area(PMA),psoas muscle index(PMI)and skeletal muscle index(SMI)of the third lumbar cross-section based on preoperative CT,total bilirubin,serum albumin,cold ischemia time,alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),gamma-glutamyl transferase(GGT),postoperative infection complications,rejection,biliary complications,death within one year and postoperative hospital stay after operation,patients with cancer collected data on whether they met the Milan criteria and whether the cancer recurred within two years after surgery.Among them,the area parameters were measured by image J.To study the statistical significance of sarcopenia and its evaluation index on the outcome of liver transplantation patients,the data were analyzed using SPSS version 26.0.The measurement data were firstly tested for normality.The measurement data of normal distribution were represented by x±s,and the comparison between groups was performed by t test;the measurement data of skewed distribution were represented by median,upper and lower quartiles.Comparisons between groups were performed using the Mann-Whitney U test.Enumeration data were expressed as cases and percentages.Between groups,χ2 test and Fisher’s exact probability method were used.Multivariate Logistic regression analysis was used for correlation research.P<0.05 was considered statistically significant.Result:(1)Statistical analysis of clinical data of patients in sarcopenia group and non-sarcopenia group showed that gender,body weight,sarcopenia index,serum cholinesterase and albumin concentration ascites,postoperative hospital stay,one-year mortality rate and postoperative infection incidence were significantly different(P<0.05).There was no significant difference in the occurrence of biliary complications after liver transplantation,the incidence of rejection,and the recurrence of cancer within two years(P >0.05).(2)The results of the Logistic regression model showed that the psoas muscle index(PMI)was an independent protective factor for the prolonged hospital stay after liver transplantation(OR=0.738 95%CI: 0.586-0.931 P=0.010),death within one year(OR=0.675 95%CI: 0.497-0.915 P =0.011)and infection complications(OR=0.643 95%CI: 0.504-0.819 P <0.001).Conclusion:Compared with non-sarcopenia patients,sarcopenia patients were more likely to have prolonged hospital stay,death within one year,and infection after liver transplantation,but they had no significantly higher rates of postoperative rejection,biliary complications,and recurrence of the cancer within two years compared with non-sarcopenic patients.Psoas muscle index(PMI)is an independent protective factor for prolonged hospital stay,death within one year,and infection complications in patients with liver transplantation.