Sarcopenia and mortality after liver transplantation.
BACKGROUND
Surgeons frequently struggle to determine patient suitability for liver transplantation. Objective and comprehensive measures of overall burden of disease, such as sarcopenia, could inform clinicians and help avoid futile transplantations.


METHODS
The cross-sectional area of the psoas muscle was measured on CT scans of 163 liver transplant recipients. After controlling for donor and recipient characteristics using Cox regression models, we described the relationship between psoas area and post-transplantation mortality.


RESULTS
Psoas area correlated poorly with Model for End-Stage Liver Disease score and serum albumin. Cox regression revealed a strong association between psoas area and post-transplantation mortality (hazard ratio = 3.7/1,000 mm(2) decrease in psoas area; p < 0.0001). When stratified into quartiles based on psoas area (holding donor and recipient characteristics constant), 1-year survival ranged from 49.7% for the quartile with the smallest psoas area to 87.0% for the quartile with the largest. Survival at 3 years among these groups was 26.4% and 77.2%, respectively. The impact of psoas area on survival exceeded that of all other covariates in these models.


CONCLUSIONS
Central sarcopenia strongly correlates with mortality after liver transplantation. Such objective measures of patient frailty, such as sarcopenia, can inform clinical decision making and, potentially, allocation policy. Additional work is needed develop valid and clinically relevant measures of sarcopenia and frailty in liver transplantation.
Englesbe
Michael J
MJ
Department of Surgery, University of Michigan, Ann Arbor, MI, USA. englesbe@umich.edu
Patel
Shaun P
SP
He
Kevin
K
Lynch
Raymond J
RJ
Schaubel
Douglas E
DE
Harbaugh
Calista
C
Holcombe
Sven A
SA
Wang
Stewart C
SC
Segev
Dorry L
DL
Sonnenday
Christopher J
CJ
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D016658:Psoas Muscles / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D055948:Sarcopenia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed