Risk factors for loss of lean body mass after liver transplantation

Background: After liver transplantation there is a fall in lean body mass. Aims: To determine the risk factors for this fall in lean body mass using univariate and subgroup analyses. Patients and Methods: Dual energy X-ray absorptiometry was performed in 36 patients (12 with Child-Pugh Class A, 20 with Class B and 4 with Class C disease) before and up to 24 months after liver transplantation. Univariate and sub-group comparative analyses were performed to assess possible risk factors for the fall in lean body mass post-transplantation. Results: The pre-transplantation serum albumin inversely correlated with the fall lean body mass at 1 month (r=0.55; p<0.009) and at 6–9 months (r=0.51; p<0.05) post-transplantation. A positive correlation between the fall in lean body mass and: (i) cumulative dose of steroids administered at 2–5 months (r = 0.57; p < 0.05) and (ii) length of hospital stay after transplantation (r=0.52; p<0.05) were also observed. Neither the severity or presence of cholestatic liver disease pre-transplant, nor acute cellular rejection post-transplant were risk factors for a fall in lean mass. Discussion: A hypercatabolic state post-transplant (represented by low albumin pre-transplantatioN), immobility, lack of exercise and steroid induced catabolism of muscle may cause the observed fall in lean mass after liver transplantation. Earlier transplantation of patients with better nuitrional status and the use of low dose steroid immunosuppressive regimens may prevent the observed fall in lean body mass after transplantation.