The present study investigated the impact of pretransplant sarcopenia on survival and sequential changes in sarcopenic parameters in patients undergoing living donor liver transplantation (LDLT). Fifty-two consecutive adult patients who underwent LDLT at Kyoto University Hospital between January 2013 and October 2014 were enrolled in this study. Sarcopenia was assessed by the measurement of skeletal muscle mass (SMM) obtained by a multifrequency body composition analyzer (InBody 720) and handgrip strength. We defined patients with sarcopenia as those with low SMM (less than 90% of the standard SMM) and low handgrip strength (less than 26kg for men, less than 18kg for women, based on the consensus report of the Asian working group for sarcopenia). The impact of pretransplant sarcopenia on short-term survival and sequential changes in sarcopenic parameters including SMM and muscle strength were analyzed. Median patient age was 56 (range, 21-68), 31 (60%) were male, median MELD score was 19 (range, 6-41). The overall survival rate in patients with sarcopenia (n=9) was significantly lower than in patients without sarcopenia (n=42) (p=0.002). SMM worsened after LDLT and did not recover to preoperative levels until 1 year after LDLT (88.9% of the preoperative level). In contrast, handgrip strength recovered to preoperative levels at 6 months after LDLT following sharp decrease at 1 month after LDLT (82.9% of the preoperative level). In conclusion, pretransplant sarcopenia was closely involved with short-term survival after LDLT and the recovery of handgrip strength preceded that of SMM.

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