A retrospective analysis of the impact of sarcopenia on liver transplantation outcome

Abstract

Background. Myosteatosis and muscle wasting (sarcopenia) are common complications of cirrhosis. Overweight patients with concurrent muscle depletion have a condition termed sarcopenic obesity. This study describes these muscle abnormalities in adult liver transplantation (LT) recipients and investigates their impact on post-transplantation outcomes. Methods. Records from 106 LT recipients were retrospectively analysed. Muscle abnormalities were determined on computed tomography using segmentation software. Myosteatosis was measured by mean muscle attenuation and sarcopenia by skeletal muscle index (SMI), determined at the third lumbar vertebra using validated gender- and body mass index (BMI)-specific cut-offs. Sarcopenic obesity was diagnosed in recipients with a BMI ≥25kg/m2 who also met the SMI cut-off for sarcopenia. Primary endpoints were the impact of these muscle abnormalities on patient and graft survival at one year after LT. Secondary outcomes were the impact on postoperative complications and length of hospital stay. Results. The majority of patients were males (n = 64, 60%) aged 50 to 64 years old (n = 47, 44%). Alcoholic and/or non-alcoholic steatohepatitis were the commonest aetiologies of cirrhosis (n = 38, 36%). Myosteatosis was present in 76 patients (72%), 69 had sarcopenia (65%) and 36 had sarcopenic obesity (34%). Myosteatosis increased the risk of mortality at one year after LT (Hazard ratio (HR) 3.3, 95% confidence interval (CI) 1.00- 11.13, p = 0.049). Sarcopenia increased the risk of death, but was of borderline significance (HR 2.64, 95% CI 0.99-7.00, p = 0.051). Patients with myosteatosis were at greater risk of allograft failure (HR 4.1, 95% CI 1.2-13.5, p = 0.021) and tended to have longer hospital stays (21, 95% CI 16-27 vs 16 days, 95% CI 10-20, p = 0.015).

Conclusions. Compared to patients without muscle abnormalities, LT recipients with myosteatosis and/or sarcopenia had an increased risk of death at one year. The risk of death was higher with myosteatosis than sarcopenia. Myosteatosis increased the risk of allograft failure at one year and these patients had a longer median length of hospital stay.