Clinical Outcomes of Living Liver Transplantation According to the Presence of Sarcopenia as Defined by Skeletal Muscle Mass, Hand Grip, and Gait Speed.

BACKGROUND: Sarcopenia is an independent predictor of death after living-donor liver transplantation (LDLT). However, the ability of the Asian Working Group for Sarcopenia criteria for sarcopenia (defined as reduced skeletal muscle mass plus low muscle strength) to predict surgical outcomes in patients who have undergone LDLT has not been determined. METHODS: This study prospectively enrolled 366 patients who underwent LDLT at Kyushu University Hospital. Skeletal muscle area (determined by computed tomography), hand-grip strength, and gait speed were measured in 102 patients before LDLT. We investigated the relationship between sarcopenia and surgical outcomes after LDLT performed in three time periods. RESULTS: The number of patients with lower skeletal muscle area has increased to 52.9% in recent years. The incidence of sarcopenia according to the Asian Working Group for Sarcopenia criteria was 23.5% (24/102). Patients with sarcopenia (defined by skeletal muscle area and functional parameters) had significantly lower skeletal muscle area and weaker hand-grip strength than did those without sarcopenia. Compared with non-sarcopenic patients, patients with sarcopenia also had significantly worse liver function, greater estimated blood loss, greater incidence of postoperative complications of Clavien-Dindo grade IV or greater (including amount of ascites on postoperative day 14, total bilirubin on postoperative day 14, and postoperative sepsis), and longer postoperative hospital stay. Multiple logistic regression analysis revealed sarcopenia as a significant predictor of 6-month mortality. CONCLUSIONS: The combination of skeletal muscle mass and function can predict surgical outcomes in LDLT patients.

Laboratory data and treatment outcomes of head and neck tumor patients in the elderly.

OBJECTIVE: To elicit the factors influencing the choice of treatment and the prognosis of elderly patients, we studied the clinical and laboratory data of head and neck tumor patients. The patients were divided into two groups (group A: younger than 75, group B: 75 years of age or older) and the treatment outcomes as well as the features of the laboratory data were analyzed. METHODS: The clinical records of 1350 patients (888 males, 462 females) with head and neck tumors who received their initial treatment at our hospital were reviewed. The collected data including age, the site of the primary lesion, pre-treatment health states, pre-operative laboratory results were examined. According to the treatment policy, we grouped the patients according to whether or not they had received the standard therapy for the disease and then analyzed their treatment outcomes. RESULTS: Standard therapy was not performed in 62 (5.6%) of the 1114 patients in group A and in 43 (18.2%) of the 236 patients in group B. A further analysis performed in group B (elderly patients) revealed that standard therapy was performed in 193 patients, while 43 received non-standard therapy. The prognosis for the non-standard therapy cases was poor. The averages of the laboratory test findings between groups A and B were compared, but no marked differences were observed. However, differences were observed in the ratio of patients whose data were in the normal range between group A and group B. When the laboratory data were compared between the standard and non-standard groups of the elderly, serum albumin and CBC (especially hemoglobin) showed a close relationship to the treatment modality. CONCLUSION: The ratio of patients who did not receive standard therapy was high in the age group of 75 years or older. The prognosis of patients with head and neck tumors is therefore considered to depend on whether or not a patient receives the standard therapy against the disease. The pre-treatment clinical data and the laboratory findings vary markedly among elderly patients 75 years of age or older. Regarding the treatment of head and neck tumors in the elderly, the laboratory data and clinical conditions of each individual patient should be checked carefully and every possible means should be employed in order to allow such patients to receive the standard therapy whenever possible.

HLA-D typing using Epstein-Barr virus-induced lymphoblastoid cell lines.

We examined whether Epstein-Barr virus-induced lymphoblastoid cell lines, established from homozygous typing cells (HTC-EBV-LCL), could be substituted for normal homozygous typing cells (HTC) in HLA-D typing. When using EBV-LCL as stimulators in one-way MLR, the stimulator: responder ratio was found to be most important. At a ratio of 1:10, the autologous MLR between EBV-LCL and PBL from the same donors exhibited low double normalized values (DNV) which could be distinguished from those of homologous combinations. The panel cells typed with HTC always exhibited low DNV in repeat one-way MLR in which EBV-LCL established from the same HTC were used. On the other hand, by employing our previously described method, we were able to establish the necessary HTC-EBV-LCL from unselected seropositive adult donors and utilize these cells for HLA-D typing. We suggest that our method makes it possible to circumvent the problem presented by the shortage of HTC, since our HTC-EBV-LCL can be substituted for normal HTC in HLA-D typing.

Epstein-Barr virus-induced lymphoblastoid cell lines from seropositive adult donors and their HLA-antigens.

Epstein-Barr virus (EBV)-induced lymphoblastoid cell lines (LCL) were established from seropositive adult Japanese donors. HLA-A, -B, -C and -DR antigens expressed on these EBV-LCL cells were identical to those of peripheral blood lymphocytes. There were no extra reactions upon DR typing; the extra reactivity in A, B and C typing was due to contaminating DR antibodies in the typing sera. In one-way mixed lymphocyte reactions with a stimulator : responder ratio between 1 : 10 and 1 : 20, autologous EBV-LCL exhibited low stimulation which could be distinguished from that of unrelated combinations. EBV-LCL may be useful for the screening of anti-DR antisera and as targets in cell-mediated lympholysis. Furthermore, EBV-LCL established from homozygous typing cells may be useful in HLA-D typing.