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2019

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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FACTORS ASSOCIATED WITH CHANGES IN BODY COMPOSITION SHORTLY AFTER ORTHOTOPIC LIVER TRANSPLANTATION: THE POTENTIAL INFLUENCE OF IMMUNOSUPPRESSIVE AGENTS

Ana Brito-Costa1, Luís Pereira-da-Silva2,3, Ana Luísa Papoila2,3, Marta Alves2, Élia Mateus4, Fernando Nolasco3,4, Eduardo Barroso3,4

1 – Dietetics and Nutrition Unit, Hospital Curry Cabral, Centro Hospitalar de Lisboa Central, Portugal;
2 – Research Unit of Centro Hospitalar de Lisboa Central, Portugal;
3 – NOVA Medical School, Universidade NOVA de Lisboa, Portugal;
4 – Transplant Center, Hospital Curry Cabral, Centro Hospitalar de Lisboa Central, Portugal.

- Transplantation 2016;100:1714-22

Background: This study aimed to determine factors associated with body composition changes shortly after liver transplantation (LTx), including the influence of immunosuppressive agents. The combined resting energy expenditure (REE) and handgrip strength provided a valuable assessment in data interpretation of body composition.
Methods: This observational single-center study included a cohort of consecutive end-stage liver disease patients with indications for LTx over two years. Cyclosporine was preferred for diabetic, hepatitis C- and human immunodeficiency-virus infected patients per the Transplant Center protocol. Subjective Global Assessment (SGA), handgrip strength, multifrequency bioelectrical impedance analysis, and REE measurements were collected. The assessments were performed before LTx (T0) and at medians of 9 (T1) and 36 (T2) days after LTx. The fat mass index (FMI) and lean mass index (LMI) were surrogates of adiposity and skeletal muscle, respectively. Multiple linear regression analysis was used.
Results: Fifty-six patients with a mean age of 53.7 (8.5) years were included; 87.5% were men. Preoperative SGA-undernourishment (β-estimate=17.9; p=0.004) and of drug addiction absence (β-estimate=14.6; p=0.049) were associated with FMI increase. Higher REE at T1 (per 100 kcal) was associated with LMI increase (β-estimate=1.70; p=0.012) and body cell mass increase (β-estimate=1.60; p=0.049). The cyclosporine-based regimen was associated with FMI decrease (β-estimate=-25.64; p<0.001) and LMI increase (β-estimate=23.76; p<0.001), when compared to a tacrolimus-based regimen. Steroids did not affect body composition.
Conclusions: The cyclosporine-based regimen was independently associated with decreased adiposity and increased skeletal muscle, compared to the tacrolimus-based regimen. Future randomized controlled trials are needed to confirm these findings. This study is part of the PhD thesis in Life Sciences - Clinical Medicine of one of the authors (Ana Brito-Costa), supervised and co-supervised by two authors (Luis Pereira-da-Silva and Fernando Nolasco, respectively) from NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.

Palavras-chave: body composition, immunosuppressive agents, liver transplantation