Chronological changes in skeletal muscle mass following living-donor liver transplantation: An analysis of the predictive factors for long-term post-transplant low muscularity.

AIM: Sarcopenia is associated with high morbidity and mortality before and after liver transplantation (LT). The aim of the study was to evaluate the chronological changes in skeletal muscle mass (SMM) at different time points post-LT and to identify the risk factors for long-term low SMM. METHODS: The skeletal muscle index at L3 level (L3-SMI) was used for muscle mass measurement, and the recommended cutoff values of the Japanese Society of Hepatology guidelines were used as criteria for defining low muscularity. RESULTS: Preoperative low SMM was recognized in 35.1% of cases. At 1 year after LDLT, 28.9% of patients showed low SMM, without any significant prevalence change in comparison with the preoperative phase (35.1%) or 1 month post-LT (30.7%). Post-LT intensive care unit (ICU) length of stay (OR 1.14, P = 0.03), biliary complications (OR 5.88, P = 0.02), pre-LT low SMM (OR 3.36, P = 0.05), and 1 month post-LT low SMM (OR 10.16, P < 0.01) were found to be independent risk factors for low SMM at 1 year post-LT in multivariate analysis. The development of de novo low SMM at 1 year post-LT was a negative prognostic factor for OS (HR 9.08, P = 0.001). CONCLUSIONS: Intensive care unit length of stay, biliary complications and preoperative and 1 month post-LT low SMM were predictive factors for long-term low SMM. Newly developed low SMM at 1 year post-LT was a prognostic factor for a poor patient survival.

Liver Transplant Experience in Syzganov's National Scientific Center of Surgery.

OBJECTIVES: Patients with chronic end-stage liver disease present a significant problem in the Republic of Kazakhstan. The liver transplant program was started in December 2011 and for May 2015, more than 80 liver transplant operations have been performed in 7 different hospitals of the country. MATERIALS AND METHODS: The main problem that hinders the wide implementation of liver transplant in our country is poor development of regularity of deceased-organ donation system. This is because of the specific mentality of the population and imperfect legislation. RESULTS: From 26 operated recipients, 19 lead a normal life (73.1%), receiving a minimal immunosuppressive therapy. In patients with cirrhosis of viral cause, there are no cases of viral hepatitis reinfection. CONCLUSIONS: Preliminary findings based on a small experience showed a good perceptiveness of developing of Liver Transplant program in Kazakhstan.

Peritoneal recurrence of initially controlled hepatocellular carcinoma after living donor liver transplantation.

It is well known that the presence of end-stage liver disease increases the risk of developing hepatocellular carcinoma (HCC). Liver transplantation (LT) for patients within the Milan criteria has become a standard treatment for HCC in most developed centers worldwide. However, a major cause of death in cirrhotic patients with HCC after transplantation is tumor recurrence, including peritoneal recurrences, which develops rarely but presents a significant problem with regard to their management. Our experience includes two cases with HCC within the Milan criteria of peritoneal recurrences after living donor LT. Both patients had interventions for HCC in their medical history before LT, and we propose that these might have been a possible cause of the HCC peritoneal recurrence.