title: Malnutrition and sarcopenia predict post-liver transplantation outcomes independently of the Model for End-stage Liver Disease score.
abstract: Although malnutrition and sarcopenia are prevalent in cirrhosis, their impact on outcomes following liver transplantation is not well documented.
  
  
  
  The associations of nutritional status and sarcopenia with post-transplant infections, requirement for mechanical ventilation, intensive care (ICU) and hospital stay, and 1 year mortality were assessed in 232 consecutive transplant recipients. Nutritional status and sarcopenia were assessed using the Royal Free Hospital-Global Assessment (RFH-GA) tool and the L3-psoas muscle index (L3-PMI) on CT, respectively.
  
  
  
  A wide range of RFH-SGA and L3-PMI were observed within similar Model for End-stage Liver Disease (MELD) sub-categories. Malnutrition and sarcopenia were independent predictors of all outcomes. Post-transplant infections were associated with MELD (OR = 1.055, 95%CI = 1.002-1.11) and severe malnutrition (OR = 6.55, 95%CI = 1.99-21.5); ventilation > 24 h with MELD (OR = 1.1, 95%CI = 1.036-1.168), severe malnutrition (OR = 8.5, 95%CI = 1.48-48.87) and suboptimal donor liver (OR = 2.326, 95%CI = 1.056-5.12); ICU stay > 5 days, with age (OR = 1.054, 95%CI = 1.004-1.106), MELD (OR = 1.137, 95%CI = 1.057-1.223) and severe malnutrition (OR = 7.46, 95%CI = 1.57-35.43); hospital stay > 20 days with male sex (OR = 2.107, 95%CI = 1.004-4.419) and L3-PMI (OR = 0.996, 95%CI = 0.994-0.999); 1 year mortality with L3-PMI (OR = 0.996, 95%CI = 0.992-0.999). Patients at the lowest L3-PMI receiving suboptimal grafts had longer ICU/hospital stay and higher incidence of infections.
  
  
  
  Malnutrition and sarcopenia are associated with early post-liver transplant morbidity/mortality. Allocation indices do not include nutritional status and may jeopardize outcomes in nutritionally compromised individuals.
authors.affiliation: UCL Institute for Liver and Digestive Health Royal Free Hospital and UCL London UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Kalafateli
authors.affiliation: UCL Institute for Liver and Digestive Health Royal Free Hospital and UCL London UK.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Mantzoukis
authors.affiliation: Department of Radiology Royal Free Hospital London NHS Foundation Trust London UK.
authors.forename: Yan
authors.initials: Y
authors.lastname: Choi Yau
authors.affiliation: Intensive Care Unit Royal Free Hospital London NHS Foundation Trust London UK; Department of Chest Diseases Minia University Egypt.
authors.forename: Ali O
authors.initials: AO
authors.lastname: Mohammad
authors.affiliation: Nutrition and Dietetics Department Royal Free Hospital London NHS Foundation Trust London UK.
authors.forename: Simran
authors.initials: S
authors.lastname: Arora
authors.affiliation: UCL Institute for Liver and Digestive Health Royal Free Hospital and UCL London UK.
authors.forename: Susana
authors.initials: S
authors.lastname: Rodrigues
authors.affiliation: UCL Institute for Liver and Digestive Health Royal Free Hospital and UCL London UK.
authors.forename: Marie
authors.initials: M
authors.lastname: de Vos
authors.affiliation: UCL Institute for Liver and Digestive Health Royal Free Hospital and UCL London UK.
authors.forename: Kassiani
authors.initials: K
authors.lastname: Papadimitriou
authors.affiliation: UCL Institute for Liver and Digestive Health Royal Free Hospital and UCL London UK.
authors.forename: Douglas
authors.initials: D
authors.lastname: Thorburn
authors.affiliation: UCL Institute for Liver and Digestive Health Royal Free Hospital and UCL London UK.
authors.forename: James
authors.initials: J
authors.lastname: O'Beirne
authors.affiliation: UCL Institute for Liver and Digestive Health Royal Free Hospital and UCL London UK.
authors.forename: David
authors.initials: D
authors.lastname: Patch
authors.affiliation: UCL Institute for Liver and Digestive Health Royal Free Hospital and UCL London UK.
authors.forename: Massimo
authors.initials: M
authors.lastname: Pinzani
authors.affiliation: UCL Institute for Liver and Digestive Health Royal Free Hospital and UCL London UK.
authors.forename: Marsha Y
authors.initials: MY
authors.lastname: Morgan
authors.affiliation: Intensive Care Unit Royal Free Hospital London NHS Foundation Trust London UK.
authors.forename: Banwari
authors.initials: B
authors.lastname: Agarwal
authors.affiliation: Department of Radiology Royal Free Hospital London NHS Foundation Trust London UK.
authors.forename: Dominic
authors.initials: D
authors.lastname: Yu
authors.affiliation: UCL Institute for Liver and Digestive Health Royal Free Hospital and UCL London UK.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
authors.affiliation: UCL Institute for Liver and Digestive Health Royal Free Hospital and UCL London UK.
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Tsochatzis
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007239:Infections / Q000000981:diagnostic imaging / Q000453:epidemiology; D007362:Intensive Care Units; D007902:Length of Stay; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016031:Liver Transplantation; D008297:Male; D044342:Malnutrition / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008875:Middle Aged; D009752:Nutritional Status; D016017:Odds Ratio; D015995:Prevalence; D012121:Respiration, Artificial; D055948:Sarcopenia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Cirrhosis; Morbidity; Mortality; Nutritional assessment; Prognosis