W. J. Bush1, A. Cabrales1, H. Underwood1, R. S. Mangus1 1Indiana University School Of Medicine,Indianapolis, IN, USA
Introduction: An increasing number of liver transplant (LT) patients are geriatric (≥ 60 years). Recent research suggests that measures of frailty, such as nutrition status, may be important predictors of surgical outcomes. This study evaluates the impact of objective measures of nutritional status on post-transplant perioperative and long term outcomes for geriatric liver transplant patients.
Methods: Patient inclusion criteria included all geriatric liver transplant patients at a single center over a 16-year time period. Measures of nutrition status included preoperative core muscle mass, perinephric and subcutaneous adipose volume, as well as standard serological markers of nutritional status (albumin, total protein and cholesterol). Measurements of total psoas muscle area, and total perinephric and subcutaneous adipose volumes were measured from preoperative computed tomography (CT) scans at the L2/L3 disc space, and scaled to patient height. Outcomes included length of hospital stay and patient survival.
Results: There were 564 patients included in the analysis, of whom 446 had preoperative CT scans available. There was poor correlation between serologic markers of nutrition and CT measures of tissue volume. Serologic markers of nutrition were poor predictors of survival, but abnormal values were associated with increased length of stay, prolonged ventilator requirement, and a non-home discharge. In contrast, patients with severe sarcopenia and poor subcutaneous and visceral adipose stores had worse long term survival, but these findings had poor correlation with perioperative outcomes. Cox regression analysis demonstrates decreased long term survival for patients with severe sarcopenia.
Conclusion: In this cohort of geriatric LT recipients, common serologic markers of nutrition were associated with perioperative clinical outcomes, while CT measures of muscle and adipose stores were more predictive of early and intermediate term survival outcomes. These results support the need for the further development of frailty measures that assess core tissue volume and physiologic strength.
