Post-transplant Muscle Mass measured by Urinary Creatinine Excretion Rate predicts Long-term Outcomes after Liver Transplantation

S.P. Stam, M.C.J. Osté, M.F. Eisenga, H. Blokzijl, A.P. van den Berg, S.J.L. Bakker, V.E.D.M. de Meijer

Thursday 15 march 2018

16:15 - 16:25h at Willem Burger Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 8: Clinical

Background

Long-term survival in orthotopic liver transplant (OLT) recipients remains impaired due to a multitude of factors, including low pre-transplant muscle mass (or sarcopenia). However, influence of post-transplant muscle mass on survival is currently unknown. We hypothesized that post-transplant urinary creatinine excretion rate (CER), an established non-invasive marker of total body muscle mass, is associated with long-term survival after OLT.

Methods

We conducted a single-center retrospective cohort study including OLT recipients ≥18 years who underwent OLT between 1993 and 2010. Baseline was set at 1-year post-transplantation. Cox-proportional hazards regression analyses were used to investigate whether CER was associated with all-cause mortality and graft failure independent of potential confounders. The cohort on which this study was based is registered at the Dutch Trial Register (NTR6650).

Results

In 382 OLT recipients (58.9% men, mean±SD age 48.5±12.5 years), mean CER at 1 year after transplantation was 13.3±3.7 mmol/24h in men and 9.4±2.6 mmol/24h in women. During median follow-up for 9.8 (interquartile range 6.4-15.0) years, 104 (27.2%) OLT recipients died and 44 (11.5%) developed graft failure. In Cox analyses, as continuous variable, low CER was associated with increased risk for all-cause mortality (HR=0.43, 95%CI: 0.26-0.71, P=0.001) and graft failure (HR=0.42, 95%CI: 0.20-0.89, P=0.02), independent of age, sex, and body surface area. Similarly, OLT recipients in the lowest tertile had an increased risk for all-cause mortality (HR=2.75; 95%CI: 1.50-5.02, P=0.001) and graft failure (HR=2.79, 95%CI: 1.04-7.45, P=0.04), compared to OLT recipients in the highest tertile.

Conclusion

Low post-transplant total body muscle mass, as measured by urinary CER, was inversely associated with an increased long-term risk of all-cause mortality and graft failure in OLT recipients. These results underline the importance of an adequate post-transplant total body muscle mass on long term survival post-OLT and may provide a rationale for future intervention studies.