Impact of sarcopenia on immunological function and outcomes in surgical treatment of refractory hepato-biliary-pancreatic diseases aiming for improvement of prognosis

2019 Fiscal Year Final Research Report

• Project/Area Number: 17K10511
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: General surgery
• Research Institution: St. Luke's International University (2019); Kyoto University (2017-2018)
• Principal Investigator: KAIDO Toshimi 聖路加国際大学, 聖路加国際病院, 部長 (80314194)
• Co-Investigator(Kenkyū-buntansha): 上本 伸二 京都大学, 医学研究科, 教授 (40252449) ; 加茂 直子 京都大学, 医学研究科, 助教 (50452355) ; 八木 真太郎 京都大学, 医学研究科, 講師 (60447969)
• Project Period (FY): 2017-04-01 – 2020-03-31
• Keywords: サルコペニア / 肝移植 / 肝胆膵癌 / 免疫 / 栄養

Outline of Final Research Achievements

1)We first clarified that preoperative low skeletal muscle mass, decreased muscle quality, and visceral adiposity were independent risk factors after liver transplantation and resection of hepato-biliary-pancreatic cancer. Implementation of new objective criteria considering preoperative body composition and perioperative rehabilitation as well as nutritional intervention dramatically improved one-year survival rate after liver transplantation (99%).
2)Surprisingly, we first demonstrated that high muscle mass and quality of male donor is a protective factor of allograft loss after living donor liver transplantation, independently from donor age.
3)Postoperative administration of β-hydroxy-β-methyl-butyrate-enriched formula with rehabilitation significantly increased grip strength at 1 and 2 months and skeletal muscle mass at 2 months and shortened postoperative hospital stay after living donor liver transplantation.

Free Research Field

消化器外科

Academic Significance and Societal Importance of the Research Achievements

肝移植や肝胆膵癌において、術前低骨格筋量や筋肉の質低下、内臓脂肪肥満が術後の独立予後不良因子であることなどを世界で初めて報告し、サルコペニア（肥満）をターゲットとした治療戦略の理論的根拠を得ることが出来た。実際、術前体組成因子に基づく客観的肝移植適応の確立と積極的な周術期リハビリ栄養介入により、肝移植後1年生存率99％ときわめて良好な成績を挙げることが出来た。さらに、肝移植後HMB（ロイシンの代謝産物）製剤投与の有用性に関するランダム化比較試験によりHMB投与群は非投与群に比べ有意に筋肉量や握力の低下を抑制したことから、難治性肝胆膵疾患における今後の治療成績向上が大いに期待される。