| Theme |
The Impact of Sarcopenia and Nutrition on Liver Diseases |
| Title |
Nutrition and Sarcopenia in Liver Transplantation and Resection |
| Author |
Toshimi Kaido |
Division of Hepato‒Biliary‒Pancreatic and Transplant Surgery, Graduate School of Medicine, Kyoto University |
| Author |
Yuhei Hamaguchi |
Division of Hepato‒Biliary‒Pancreatic and Transplant Surgery, Graduate School of Medicine, Kyoto University |
| Author |
Shinya Okumura |
Division of Hepato‒Biliary‒Pancreatic and Transplant Surgery, Graduate School of Medicine, Kyoto University |
| Author |
Atsushi Kobayashi |
Division of Hepato‒Biliary‒Pancreatic and Transplant Surgery, Graduate School of Medicine, Kyoto University |
| Author |
Hisaya Shirai |
Division of Hepato‒Biliary‒Pancreatic and Transplant Surgery, Graduate School of Medicine, Kyoto University |
| Author |
Shinji Uemoto |
Division of Hepato‒Biliary‒Pancreatic and Transplant Surgery, Graduate School of Medicine, Kyoto University |
| [ Summary ] |
Most patients undergoing liver transplantation (LT) or liver resection for hepatocellular carcinoma (HCC) meet the criteria of sarcopenia and require perioperative nutritional treatment due to protein‒energy malnutrition. In such patients, low skeletal muscle mass and low muscle quality were independent risk factors for poor survival. However, patients who received perioperative nutritional therapy including preoperative branched‒chain amino acids and postoperative early enteral nutrition had significantly better survival than those who did not. Accordingly, in 2013, we modified our indication criteria for LT considering sarcopenia. Short‒term survival after LT has dramatically improved. as a result. Skeletal muscle mass worsened after living‒donor LT and did not recover to preoperative levels until 1 year postoperative. In contrast, hand‒grip strength recovered to preoperative levels at 6 months postoperative. Low muscle quality also plays an important role in HCC recurrence after liver resection. Moreover, in patients with normal muscle quality postoperative, muscle quality worsening was an independent risk factor for HCC recurrence. Taken together, postoperative mid‒ or long‒term nutritional and rehabilitation interventions are needed to improve both patient survival and quality of life. |