title: Body composition assessed by dual-energy X-ray absorptiometry predicts early infectious complications after liver transplantation.
abstract: It is challenging to identify malnutrition, which is a risk factor for poor outcome in patients with liver cirrhosis. In the present study, we aimed to investigate the prevalence of malnutrition among patients listed for liver transplantation, as assessed by different methods, and also to relate dual-energy X-ray absorptiometry (DXA) to short-term post-transplant outcomes.
  
  
  
  In this retrospective cohort study, we reviewed the medical records of 106 patients who underwent liver transplantation in 2009-2012. Body composition was assessed by the fat-free mass index (FFMI) and fat mass index (FMI) obtained using DXA. Severe infections within 1 month, length of stay in intensive care unit and length of hospital stay were endpoints of primary interest.
  
  
  
  The prevalence of malnutrition was 2-20% depending on sex and the assessment method. Thirty-nine (37%) patients developed severe infections within 1 month after liver transplantation. In multivariate analysis with logistic regression, body composition was significantly associated with post-operative infection when measured with FFMI (P = 0.043) but not with FMI (P = 0.087). Post-operative dialysis (P = 0.004) and post-operative infections (P < 0.001) were significantly associated with length of stay in hospital. Post-operative bleeding (P = 0.015), duration of mechanical ventilation (P < 0.001) and the need for dialysis (P < 0.001), but not body composition, were significant predictors of the length of stay in the intensive care unit.
  
  
  
  The prevalence of malnutrition depends on assessment method. FFMI is an independent predictor for early post-transplant infections. Body composition measured by DXA during the pretransplant evaluation provides valuable information about nutritional status in patients with liver cirrhosis.
authors.affiliation: Department of Clinical Nutrition and Dietetics, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Lindqvist
authors.affiliation: Department of Gastroenterology and Hepatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Majeed
authors.affiliation: Department of Gastroenterology and Hepatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Wahlin
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D001823:Body Composition; D003141:Communicable Diseases / Q000453:epidemiology* / Q000209:etiology; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors
keywords: body composition; dual-energy X-ray absorptiometry; fat free mass index; liver transplantation; outcome