AUTHOR=Tomiyama Takahiro , Harada Noboru , Toshima Takeo , Nakayama Yuki , Toshida Katsuya , Morinaga Akinari , Kosai-Fujimoto Yukiko , Tomino Takahiro , Kurihara Takeshi , Takeishi Kazuki , Nagao Yoshihiro , Morita Kazutoyo , Itoh Shinji , Yoshizumi Tomoharu 

TITLE=Donor Skeletal Muscle Quality Affects Graft Mortality After Living Donor Liver Transplantation- A Single Center, Retrospective Study

JOURNAL=Transplant International

VOLUME=Volume 35 - 2022

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10723

DOI=10.3389/ti.2022.10723

ISSN=1432-2277

ABSTRACT=Aim: The recipient muscle status is closely associated with postoperative poor survival in recipients of living donor liver transplantation (LDLT). Regular exercise improves donor healthy status and liver steatosis. However, it is uncertain that LDLT donor muscle quality and quantity affect graft quality. Hence, we analyzed the correlation between donor muscle status and the graft function.
Methods: We measured skeletal muscle mass index (SMI) and intramuscular adipose tissue content (IMAC) for total 380 LDLT donors with preoperative CT images at the level of third lumbar. Donor SMI and IMAC were used markers of muscle quantity and quality, respectively. We examined the correlation between donor SMI or IMAC, and graft mortality; the occurrence rates of small-for-size graft syndrome, and 6-month graft survival rates. 
Results: Donor SMI had no effect on the occurrence of small-for-size graft (SFSG) syndrome and graft survival, while both male and female donor high IMAC was significantly correlated with the rate of SFSG syndrome [High vs low: (male donors) 15.8% vs 2.5%, p=0.0003, (female donors) 12.8% vs 3.1%, p=0.0234], and 6-month graft survival rates [(male donors) 87.7% vs 95.9%, p=0.02, (female) 83.0% vs 99.0%, p<0.0001]. Multivariate analysis revealed that high donor IMAC (HR; 5.42, CI; 2.13-13.8, p=0.0004), were one of the independent risk factors for graft failure within 6-month.
Conclusion: Both high male and female IMAC, including absence of splenectomy and high MELD score, may be useful to predict the graft survival in LDLT and donor IMAC is useful for donor selection of high risk recipient.