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

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. 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 third and fourth 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). 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) mm2/m2 and 95.3% (89.9%–101.1%). On POD 21, the values were 297.8 (258.5–349.6) mm2/m2 and 90.7% (81.1%–99.2%). In men, they were 335.3 (276.7–389.4) mm2/m2 and 94.2% (89.0%–98.8%) on POD 7, and 305.0 (271.6–357.0) mm2/m2 and 89.2% (83.2%–98.2%) on POD 21. In women, they were 281.2 (231.1–313.7) mm2/m2 and 101.4% (95.2%–106.0%) on POD 7, and 260.7 (245.9–273.9) mm2/m2 and 98.9% (77.9%–124.3%) on POD 21. Patients undergoing ABOi LDLT were most vulnerable to core muscle loss soon after surgery. •Since the introduction of rituximab, ABO-incompatible living-donor liver transplantation has gradually become accepted as a feasible therapy for end-stage liver disease.•Patients with end-stage liver disease experience progressive muscle loss (sarcopenia) associated with poor posttransplantation outcomes.•We are the first to show that patients undergoing ABO-incompatible living-donor liver transplantation become maximally vulnerable to core muscle loss soon after surgery.