Osteopenia predicts posttransplant survival among living-donor liver transplant recipients
Takeo Toshima1, Noboru Harada1, Shinji Itoh1, Kazutoyo Morita1, Yoshihiro Nagao1, Takeshi Kurihara1, Takahiro Tomino1, Yukiko Kosai-Fujimoto1, Akinari Morinaga1, Takahiro Tomiyama1, Katsuya Toshida1, Tomoharu Yoshizumi1.
1Department of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan
Introduction: Osteopenia, loss of bone mineral density (BMD), was recently identified to be independently associated with early marker of deconditioning that precedes sarcopenia. However, little evidence about the prognostic value of osteopenia in patients undergoing LT has been reported. The aim of this study was to clarify the impact of osteopenia as the risk factor for mortality after living-donor liver transplantation (LDLT) compared with already-reported predictors in a large cohort of Japanese patients with liver cirrhosis.
Methods: Data were collected retrospectively for all consecutive 609 patients who underwent LDLT at our institution between January 2001 and Nobember 2019. BMD was evaluated with computed tomographic measurement of pixel density in the midvertebral core of the 11th thoracic vertebra by computed tomography. Data related to clinicopathological parameters and prognosis were analyzed with dividing into two groups; acute liver failure groups (n=62) and decompensated liver cirrhosis (n=547).
Results: (1) Acute liver failure groups (n=62): The median value of BMD was 210.4 Hounsfield units (HU). Osteopenia was identified in 18 (29.0%) of 62 recipients, according to the calculated age-specific standard BMD values. The overall survival of the patients of osteopenia was similar to that of patients with non-osteopenia (P-value=0.052; 5y, 55.6% vs. 76.8%). (2) Decompensated liver cirrhosis groups (n=547): The median value of BMD was 171.6 Hounsfield units (HU). Osteopenia was identified in 251 (45.9%) of 547 recipients. The overall survival of the patients with osteopenia was significantly lower than the patients with non-osteopenia (P-value<0.001; 5y, 71.5% vs. 89.7%). In addition to the other predictors, such as preoperative admission in intensive/high care unit (ICU) (HR 2.268, P=0.029) and no splenectomy during LT (HR 1.991, P=0.001), osteopenia (HR 3.029, P=0.001) was independent risk factors for mortality after LDLT by multivariate analysis.
Conclusion: Preoperative osteopenia was independently associated with post-LDLT mortality among patients with decompensated liver cirrhosis. Improving osteopenia with preoperative rehabilitation or medical therapy may improve post-LDLT survival.
I, (Takeo Toshima) DO NOT have a financial interest/arrangement or affiliation with one or more organizations which could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.
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