Clinical Impact of Preoperative Sarcopenia on the Postoperative Outcomes After Pancreas Transplantation

Background: The importance of evaluating sarcopenia is increasingly being recognized in the field of transplantation because sarcopenia can have an adverse effect on the treatment outcomes. However, the clinical significance of preoperative sarcopenia on the postoperative outcomes following pancreas transplantation (PTx) has been largely unknown. The objective of this study was to investigate the role of preoperative sarcopenia in predicting the postoperative outcomes following PTx in recipients with type 1 diabetes mellitus (T1D). Methods: Forty-one recipients with severe T1D who underwent PTx were retrospectively reviewed. The psoas muscle mass index (PMI) and intramuscular adipose tissue content (IMAC), as determined by preoperative computed tomography, were substituted for the quantity and quality of skeletal muscle for the definition of sarcopenia, respectively. Gender-specific quartiles were generated, and PMI lower than the first quantile or IMAC higher than the third quantile was considered to represent sarcopenia. The postoperative outcomes included postoperative surgical complications and pancreas graft survival. Results: Sarcopenia was identified in 11 recipients according to both the PMI and IMAC stratifications. The multivariate analyses revealed that high IMAC was independently associated with the development of postoperative surgical complications (odds ratio, 9.35; p = 0.016). In addition, the recipients with high IMAC showed unfavorable graft survival compared to those with normal IMAC (log-rank test; p = 0.038). In contrast, low PMI was not significantly associated with the postoperative outcomes. Conclusions: Our data suggested that preoperative sarcopenia, especially a decline in the quality of skeletal muscle, predicted poorer postoperative outcomes in T1D recipients undergoing PTx.