CT based sarcopenia assessment & frailty scores are better than PELD in predicting early morbidity and mortality after paediatric live donor liver transplantation
R.V. Sugi Subramaniam1, Mettu Srinivas Reddy1, Jagadeesh Menon3, Pradeep Krishna1, Naresh Shanmugham3, Rathnavel Kanagavelu2, Ravikumar Thambithurai4, Mohamed Rela1.
1Liver Transplant and Hepatopancreaticobiliary Surgery, Dr. Rela Institute and Medical Centre, Chennai, India; 2Liver Anesthesia and Intensive Care, Dr. Rela Institute and Medical Centre, Chennai, India; 3Paediatric Hepatology and Gastroenterology, Dr. Rela Institute and Medical Centre, Chennai, India; 4Paediatric Intensive Care, Dr. Rela Institute and Medical Centre, Chennai, India
Background: There is limited evidence for the role of sarcopenia and frailty in predicting outcomes after pediatric living donor liver transplantation (pLDLT).
Methods: Children (6months-10years) undergoing pLDLT for non-ALF indications at a single center between Jan2019 and August2019 were enrolled. CT scan was performed as part of pLDLT evaluation. Psoas muscle cross-sectional area on plainCT at L3 (PCSA) was measured. Severity of sarcopenia was reported as z- scores calculated by comparing with PCSA scores of age-matched healthy children who underwent CT for trauma or foreign-body ingestion. Frailty was assessed using both Lansky’s Play performance scale (LPPS) and Functional status score (FSS) via questionnaires administered to children or their carers. Clinical, peri-operative and outcome data was collected. Predictors of prolonged ventilation (>72 hours), major-morbidity (Clavien-Dindo score>2) and 90-day mortality were analysed.
Results: 46 children were prospectively enrolled. Median (IQR) age, weight & PELD were 16mths(10,72 ), 9.2 kg (6.7,16.2), and 17(6,27.5). Median sarcopenia score was -1.42 (-2.26, -0.79). Median scores on LPPS and FSS scales were 60(40,90) & 6 (6,8.25). Median duration of post-op ventilation was 2 days (1,2.5). 24 (52.2%) children had atleast one post-op complication while 14 (30.4%) suffered major-morbidity. 5(10.9%) children died within 90 days. Predictors of major-morbidity on univariate analysis (UVA) were weight(p=0.007), sarcopenia (p=0.009), PELD(p=0.029) and GRWR(p=0.028). Multivariate analysis (MVA) identified sarcopenia as the only independent factor (odds ratio 0.589 (95%ci 0.384,0.903), p=0.015). Factors associated with prolonged ventilation were etiology, weight, sarcopenia, LPPS & FSS scores. On MVA, sarcopenia (odds ratio: 0.581 (95%ci 0.361,0.934), p=0.025) and LPPS (odds ratio: 0.952 (95%ci 0.910-995), p=0.029) were identified as independent factors. Predictors of post-op mortality were etiology, age, sarcopenia & FSS. On MVA, sarcopenia (odds ratio- 1.934 (95% ci- 1.147, 3.260), p=0.013) alone predicted 90-day post-op mortality.
Conclusion: Sarcopenia and frailty are promising predictors of early outcomes after pLDLT.
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