title: Morphometric age and mortality after liver transplant.
abstract: OBJECTIVE
  Morphometric assessment has emerged as a strong predictor of postoperative morbidity and mortality. However, a gap exists in translating this knowledge to bedside decision making. We introduced a novel measure of patient-centered surgical risk assessment: morphometric age.
  
  
  OBJECTIVE
  To investigate the relationship between morphometric age and posttransplant survival.
  
  
  METHODS
  Medical records of recipients of deceased-donor liver transplants (study population) and kidney donors/trauma patients (morphometric age control population).
  
  
  METHODS
  A retrospective cohort study of 348 liver transplant patients and 3313 control patients. We assessed medical records for validated morphometric characteristics of aging (psoas area, psoas density, and abdominal aortic calcification). We created a model (stratified by sex) for a morphometric age equation, which we then calculated for the control population using multivariate linear regression modeling (covariates). These models were then applied to the study population to determine each patient's morphometric age.
  
  
  METHODS
  All analytic steps related to measuring morphometric characteristics were obtained via custom algorithms programmed into commercially available software. An independent observer confirmed all algorithm outputs. Trained assistants performed medical record review to obtain patient characteristics.
  
  
  RESULTS
  Cox proportional hazards regression model showed that morphometric age was a significant independent predictor of overall mortality (hazard ratio, 1.03 per morphometric year [95% CI, 1.02-1.04; P < .001]) after liver transplant. Chronologic age was not a significant covariate for survival (hazard ratio, 1.02 per year [95% CI, 0.99-1.04; P = .21]). Morphometric age stratified patients at high and low risk for mortality. For example, patients in the middle chronologic age tertile who jumped to the oldest morphometric tertile have worse outcomes than those who jumped to the youngest morphometric tertile (74.4% vs 93.2% survival at 1 year [P = .03]; 45.2% vs 75.0% at 5 years [P = .03]).
  
  
  CONCLUSIONS
  Morphometric age correlated with mortality after liver transplant with better discrimination than chronologic age. Assigning a morphometric age to potential liver transplant recipients could improve prediction of postoperative mortality risk.
authors: Morphomics Analysis Group, Department of Surgery, University of Michigan Medical School, Ann Arbor.
authors: Seth A
authors: SA
authors: Waits
authors: Morphomics Analysis Group, Department of Surgery, University of Michigan Medical School, Ann Arbor.
authors: Edward K
authors: EK
authors: Kim
authors: Morphomics Analysis Group, Department of Surgery, University of Michigan Medical School, Ann Arbor.
authors: Michael N
authors: MN
authors: Terjimanian
authors: currently an undergraduate at University of Michigan, Ann Arbor.
authors: Lindsay M
authors: LM
authors: Tishberg
authors: Morphomics Analysis Group, Department of Surgery, University of Michigan Medical School, Ann Arbor.
authors: Calista M
authors: CM
authors: Harbaugh
authors: Morphomics Analysis Group, Department of Surgery, University of Michigan Medical School, Ann Arbor.
authors: Kyle H
authors: KH
authors: Sheetz
authors: Morphomics Analysis Group, Department of Surgery, University of Michigan Medical School, Ann Arbor.
authors: Christopher J
authors: CJ
authors: Sonnenday
authors: Morphomics Analysis Group, Department of Surgery, University of Michigan Medical School, Ann Arbor.
authors: June
authors: J
authors: Sullivan
authors: Morphomics Analysis Group, Department of Surgery, University of Michigan Medical School, Ann Arbor.
authors: Stewart C
authors: SC
authors: Wang
authors: Morphomics Analysis Group, Department of Surgery, University of Michigan Medical School, Ann Arbor.
authors: Michael J
authors: MJ
authors: Englesbe
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D046148:Donor Selection / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014019:Tissue Donors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome