Background and Objectives: Glucose instability has been established to be related to postoperative morbidity and mortality in liver transplantation. To date, the impact of maintaining optimal blood glucose (BG) levels on the incidence of acute kidney injury (AKI) following liver transplantation (LT) remains unclear. This study aimed to determine the impact of optimal BG level after reperfusion (REP BG) on the incidence of AKI after living donor LT (LDLT). Materials and Methods: This study retrospectively reviewed 3331 patients who underwent LDLT between January 2008 and December 2019. Patients were divided into optimal (110 mg/dL < BG < 180 mg/dL) and non-optimal (BG < 110 mg/dL or >180 mg/dL) REP BG groups. Multivariable logistic regression analysis was performed to assess factors associated with AKI. Propensity score matching (PSM) was used to compare the incidence of AKI, AKI severity, and progression to chronic kidney disease (CKD) between the groups. Results: The incidence of AKI was 66.7%. After PSM, patients in the optimal REP BG group showed a lower incidence of AKI (66.5% vs. 70.6%, p = 0.032). Multivariable logistic regression analysis showed that the non-optimal REP BG group was independently associated with a higher risk of AKI (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.02–1.45; p = 0.037) compared to the optimal group. Similarly, the risks of severe AKI (OR, 1.32; 95% CI, 1.11–1.58; p = 0.002) and progression to CKD (OR, 1.19; 95% CI, 1.01–1.41; p = 0.039) were significantly higher in the non-optimal group after PSM. Conclusions: Maintenance of an optimal REP BG was associated with a significantly lower incidence of AKI and a reduced risk of progression to CKD within 1 year after LDLT.

Background/Objectives: Laparoscopic living donor hepatectomy may compromise hepatic microcirculation and exacerbate ischemia–reperfusion injury. Evidence regarding the effects of dexmedetomidine on donor liver injury and graft outcomes in laparoscopic living donor liver transplantation (LDLT) remains limited. Methods: We conducted a retrospective cohort study of adult donor–recipient pairs undergoing purely laparoscopic living donor hepatectomy with the Pringle maneuver, categorized by intraoperative dexmedetomidine administration. Primary outcomes were postoperative donor liver function and lactate dynamics. Secondary outcomes included recipient postoperative liver function, perioperative lactate dynamics, early allograft dysfunction (EAD), and graft failure. A 1:1 propensity score matching was performed, and longitudinal laboratory trends were analyzed using linear mixed-effects models. Results: Among 395 donor–recipient pairs, 168 matched pairs (84 per group) were analyzed after PSM. Donors receiving dexmedetomidine had significantly lower postoperative peak aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels (both p < 0.01), with significant group-by-time interactions (AST p < 0.001; ALT p = 0.013). Lactate trajectories differed significantly between groups in both donors and recipients (p for interaction < 0.001). In recipients, there were no significant differences between the two groups in EAD (2.4% vs. 8.3%; OR, 0.31; 95% CI, 0.07–1.35; p = 0.168) and one-year graft survival (1.2% vs. 4.8%; HR, 0.36; 95% CI, 0.04–7.20; p = 0.251). Conclusions: Intraoperative dexmedetomidine administration in living liver donors was associated with reduced biochemical evidence of hepatocellular injury and improved perioperative metabolic profiles. These findings suggest a potential donor-level protective effect without demonstrable early clinical benefit in recipients, supporting the need for prospective studies to clarify its clinical significance.

Background/Objectives: Sarcopenia adversely affects outcomes after liver transplantation. The CT-based skeletal muscle index (SMI) is a validated prognostic measure but requires dedicated image analysis. We evaluated the diagnostic performance of creatinine/cystatin C-based serum muscle indices for identifying CT-defined sarcopenia and their prognostic value for graft failure in living donor liver transplantation (LDLT) recipients. Methods: We retrospectively analyzed 802 LDLT recipients (January 2023–April 2026). Using serum creatinine- and cystatin C-based equations, we calculated total body muscle mass (TBMM), appendicular skeletal muscle mass (ASM), and predicted SMI, and derived height-squared-normalized indices (TBMMI, ASMI); the creatinine-to-cystatin C ratio served as a non-equation-based comparator. CT-defined sarcopenia was classified using sex-specific reference cutoffs (males < 39.9, females < 28.9 cm²/m²). Diagnostic accuracy was assessed with sex-stratified ROC curves and DeLong test. The primary outcome was graft failure (recipient death or re-transplantation); its association with the best-performing index at 180 days, 1 year, and 3 years was evaluated using multivariable Cox models. Results: TBMMI showed the strongest correlation with SMI (r = 0.75). TBMMI discriminated CT-defined sarcopenia well (AUC 0.845 in males, 0.828 in females). After multivariable adjustment, each 1 kg/m² decrease in TBMMI was independently associated with graft failure at 180 days (adjusted hazard ratio [HR] 1.42, 95% CI, 1.14–1.78), 1 year (HR 1.28, 1.05–1.56), and 3 years (HR 1.20, 1.02–1.40) (all p < 0.05). Conclusions: TBMMI is an accessible, non-imaging surrogate for SMI in LDLT recipients, and a lower TBMMI is independently associated with postoperative graft failure.