Sarcopenia and Post-Liver Transplant Mortality

By M. Englesbe, Shaun P. Patel, Kevin He, Raymond J. Lynch, D. Schaubel, C. Harbaugh, S. Holcombe, Stewart C. Wang, D. Segev, C. Sonnenday. Journal of the American College of Surgeons, 2010

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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 transplants. Study Design 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-transplant mortality. Results Psoas area correlated poorly with MELD score and serum albumin. Cox regression revealed a strong association between psoas area and post-transplant mortality (HR=3.7 per 1000 mm2 decrease in psoas area (p<0.0001). Upon stratification into quartiles based on psoas area (holding donor and recipient characteristics constant), one 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 three years among these groups was 26.4% and 77.2%, respectively. The impact of psoas area on survival exceeded that all other covariates in these models. Conclusions Central sarcopenia strongly correlates with post-liver transplant mortality. Such objective measures of patient frailty such as sarcopenia may inform clinical decision making and potentially allocation policy. Further work is needed develop valid and clinically relevant measures of sarcopenia and frailty in liver transplantation.

Subfields: Hepatology, Physiology, Surgery

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