title: Systematic Review and Meta-Analysis of the Impact of Computed Tomography-Assessed Skeletal Muscle Mass on Outcome in Patients Awaiting or Undergoing Liver Transplantation.
abstract: Liver transplant outcome has improved considerably as a direct result of optimized surgical and anesthesiological techniques and organ allocation programs. Because there remains a shortage of human organs, strict selection of transplant candidates remains of paramount importance. Recently, computed tomography (CT)-assessed low skeletal muscle mass (i.e. sarcopenia) was identified as a novel prognostic parameter to predict outcome in liver transplant candidates. A systematic review and meta-analysis on the impact of CT-assessed skeletal muscle mass on outcome in liver transplant candidates were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Nineteen studies, including 3803 patients in partly overlapping cohorts, fulfilled the inclusion criteria. The prevalence of sarcopenia ranged from 22.2% to 70%. An independent association between low muscle mass and posttransplantation and waiting list mortality was described in 4 of the 6 and 6 of the 11 studies, respectively. The pooled hazard ratios of sarcopenia were 1.84 (95% confidence interval 1.11-3.05, p = 0.02) and 1.72 (95% confidence interval 0.99-3.00, p = 0.05) for posttransplantation and waiting list mortality, respectively, independent of Model for End-stage Liver Disease score. Less-consistent evidence suggested a higher complication rate, particularly infections, in sarcopenic patients. In conclusion, sarcopenia is an independent predictor for outcome in liver transplantation patients and could be used for risk assessment.
authors.affiliation: Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: J L A
authors.initials: JL
authors.lastname: van Vugt
authors.affiliation: Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Levolger
authors.affiliation: Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: R W F
authors.initials: RW
authors.lastname: de Bruin
authors.affiliation: Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van Rosmalen
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: H J
authors.initials: HJ
authors.lastname: Metselaar
authors.affiliation: Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: J N M
authors.initials: JN
authors.lastname: IJzermans
mesh_terms: D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000473:pathology*; D011379:Prognosis; D055948:Sarcopenia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: classification systems; clinical research/practice; comorbidities; complication; complication: infectious; diagnostic techniques and imaging: computed tomography; health services and outcomes research; liver transplantation/hepatology