Sarcopenia in Children With End‐Stage Liver Disease

• DOI: 10.1097/mpg.0000000000001792
• Publication Date: 2017-10-26T22:56:32Z
• Authors: Eberhard Lurz; Hiten Patel; Richard G. Frimpong; Amanda Ricciuto; Mohit Kehar; Paul W. Wales; Alexander J. Towbin; Govind B. Chavhan; Binita M. Kamath; Vicky L. Ng
• Keywords: Male; Sarcopenia; Adolescent; Infant; Pilot Projects; Liver Transplantation; 3. Good health; End Stage Liver Disease; 03 medical and health sciences; 0302 clinical medicine; Child, Preschool; Humans; Female; Child; Muscle, Skeletal; Tomography, X-Ray Computed; Retrospective Studies

ABSTRACTBackground:Sarcopenia, reflected by decreased psoas muscle surface area (PMSA), has been identified as a novel and independent predictor of wait‐list mortality and outcomes in adult liver transplantation (LT). We hypothesized that children with end‐stage liver disease (ESLD) would have smaller PMSA than healthy controls.Methods:Computer tomography images of children (ages 0 to 18 years) listed for LT in 2015 and a control group comprised 2:1 age‐ and gender‐matched healthy pediatric trauma victims were reviewed. PMSA was determined at 2 intervertebral disc (L3/4; L4/5) levels. A subset of images was reviewed by 2 radiologists to determine interrater correlation.Results:A total of 23 children with ESLD were included, and the most prevalent diagnosis was biliary atresia (61%). On both lumbar levels, median PMSA was significantly smaller in ESLD subjects compared with the 46 healthy controls (L4/5; median total PMSA (tPMSA) 407 mm2 (interquartile range 339–537) versus controls 513 mm2 (interquartile range 437–672); P = 0.004), independent of participants’ weight z scores (r = 0.01; P = 0.95). Excellent interrater correlation was seen (intraclass correlation 0.99).Conclusions:In this retrospective pilot study, PMSA was significantly lower in children with ESLD compared with healthy age‐ and gender‐matched controls. Because this finding was independent of growth in ESLD subjects, PMSA may represent a novel objective nutritional biomarker in children with advanced liver disease.