Outcomes After Liver Transplantation in Sarcopenic Children: A Retrospective Analysis

Background Data on the impact of sarcopenia are limited in pediatric liver transplantation (LT). In contrast, sarcopenia has been extensively studied in adult LT recipients and has been shown to be associated with increased postoperative morbidity and mortality. Aims To evaluate the incidence and postoperative impact of sarcopenia in children having undergone LT. Methods This retrospective review included children (0-16 years) with LT, from 2004-2023. They were divided into two groups: sarcopenic vs non-sarcopenic patients, according to the Total Skeletal Muscle Index (TSMI)-score calculated on preoperative CT (with median TSMI-score in the second quintile as cut-off). Children with multi-organ transplants were excluded. Preoperative variables and postoperative complications during the first year post-LT were compared between the two groups. Results One hundred eleven patients were included, 78/111 (70%) were sarcopenic, 33/111 (30%) were not. Median TSMI-score was 2244 mm2/m2 (IQR 1984-2464). At LT, 75/111 patients (68%) received nutritional support, including 24/33 (73%) sarcopenic patients. Lower weight z-scores (p=0.03) and lower BMI (p<0.001) significantly correlated with sarcopenia. ICU length of stay was significantly longer in sarcopenic patients (p=0.035), whereas postoperative intubation time and overall hospital-stay did not differ between groups. Vascular, intestinal, biliary, infectious, neurological postoperative complications, and rate of reoperations were not significantly different between groups. In contrast, graft rejection during the first year post-LT was significantly associated with sarcopenia (p=0.003). Patient and graft survival did not differ between groups. Conclusion In this cohort of liver-transplanted children, sarcopenia was associated with prolonged ICU-stay and increased graft rejection within the first year post-LT. Interestingly and in contrast to adult series, surgical and infectious postoperative complications did not differ between groups. Further studies are needed to determine whether preoperative nutritional optimization, physiological resilience, or enhanced postoperative care might mitigate the clinical impact of sarcopenia in pediatric LT recipients.