63rd Annual Meeting of the American-Association-for-the-Study-of-Liver-Diseases (AASLD) location:Boston: MA date:NOV 09-13, 2012
BACKGROUND:Invalidating polycystic liver disease (PLD) with
extreme hepatomegaly can be an indication for liver transplantation(LT. In Eurotransplant,a decreased mid-upper arm circumference(MUAC) is used to give symptomatic pts priority on the waiting list (female: <23.1;men:<23.8cm. This is based on the assumption that decreased MUAC reflects malnutrition but this has never been validated in PLD.
AIM:To study the prevalence of malnutrition assessed by sarcopenia (depletion of skeletal muscle) in symptomatic PLD.
METHODS:Liver volume (LV);skeletal muscle area (SMA) and subcutaneous adipose tissue (SAT) at vertebra L3 were measured by single CT-scanning. Skeletal muscle area was corrected for stature (SMA-index).Sarcopenia was defined as SMA-index <38.5cm^2/h^2 (female);<52.4cm^2/h^2 (men). LV was corrected for body surface area (LV-index).Lean body mass was estimated from skeletal muscle area.
RESULTS:Studygroup(n=43):39 women;mean age of 51y.Sarcopenia was present in 42%;decreased MUAC in 37%.Pts were divided in 4 groups: A/decreased MUAC and sarcopenia
(n=8);B/decreased MUAC and no sarcopenia (n=8);C/no
decreased MUAC with sarcopenia (n=7);D/no decreased
MUAC and no sarcopenia.There was no difference regarding
age & creatinine clearance.In group A,pts had larger liver volumes than group C (p<0.05).Group C had normal MUAC but
more subcutanous fat (p<0.05).The LV-index in group A was
higher than in group C and D (p<0.05).In group D,pts had
more lean body mass and subcutaneous fat vs the other groups
(p<0.05).MUAC was well correlated with subcutaneous fat
(r=0.759;P<0.0001) but less with lean body mass
(r=0.393,p=0.009).Pts were then divided in group LT (n=20) vs no LT (n=23).12 pts of group LT had no decreased MUAC,
however 25% was sarcopenic. CONCLUSION: Sarcopenia is
highly prevalent is pts with symptomatic PLD (42%).MUAC is
more strongly correlated with subcutaneous fat rather than lean body mass;as such a subgroup with sarcopenia despite normal MUAC exists.The SMA and LV indexes are objective parameters to asses malnutrition in PLD pts. These parameters should also be taken into consideration in the allocation for LT.