Ct Based Sarcopenia Assessment & Frailty Scores Are Better Than Peld In Predicting Early Morbidity And Mortality After Paediatric Live Donor Liver Transplantation

Background: There is limited evidence for the role of sarcopenia and frailty in predicting outcomes after pediatric living donor liver transplantation (pLDLT). Methods: Children (6months-10years) undergoing pLDLT for non-ALF indications at a single center between Jan2019 and August2019 were enrolled. CT scan was performed as part of pLDLT evaluation. Psoas muscle cross-sectional area on plainCT at L3 (PCSA) was measured. Severity of sarcopenia was reported as z- scores calculated by comparing with PCSA scores of age-matched healthy children who underwent CT for trauma or foreign-body ingestion. Frailty was assessed using both Lansky’s Play performance scale (LPPS) and Functional status score (FSS) via questionnaires administered to children or their carers. Clinical, peri-operative and outcome data was collected. Predictors of prolonged ventilation (>72 hours), major-morbidity (Clavien-Dindo score>2) and 90-day mortality were analysed. Results: 46 children were prospectively enrolled. Median (IQR) age, weight & PELD were 16mths(10,72), 9.2 kg (6.7,16.2), and 17(6,27.5). Median sarcopenia score was -1.42 (-2.26, -0.79). Median scores on LPPS and FSS scales were 60(40,90) & 6 (6,8.25). Median duration of post-op ventilation was 2 days (1,2.5). 24 (52.2%) children had atleast one post-op complication while 14 (30.4%) suffered major-morbidity. 5(10.9%) children died within 90 days. Predictors of major-morbidity on univariate analysis (UVA) were weight(p=0.007), sarcopenia (p=0.009), PELD(p=0.029) and GRWR(p=0.028). Multivariate analysis (MVA) identified sarcopenia as the only independent factor (odds ratio 0.589 (95%ci 0.384,0.903), p=0.015). Factors associated with prolonged ventilation were etiology, weight, sarcopenia, LPPS & FSS scores. On MVA, sarcopenia (odds ratio: 0.581 (95%ci 0.361,0.934), p=0.025) and LPPS (odds ratio: 0.952 (95%ci 0.910-995), p=0.029) were identified as independent factors. Predictors of post-op mortality were etiology, age, sarcopenia & FSS. On MVA, sarcopenia (odds ratio- 1.934 (95% ci- 1.147, 3.260), p=0.013) alone predicted 90-day post-op mortality. Conclusion: Sarcopenia and frailty are promising predictors of early outcomes after pLDLT.