WHAT IS KNOWNSarcopenia is associated with increased mortality in patients with cirrhosisThe impact of sarcopenia in patients undergoing TIPSS insertion for refractory ascites is unknown WHAT IS NEW Sarcopenia is not associated with worse outcome after TIPSS insertion for refractory ascites Sarcopenia is not associated with increased incidence of encephalopathy following TIPSS insertion for refractory ascites Insertion of TIPSS in patients with refractory ascites might lead to improvement in muscle mass ABSTRACT ObjectivesThe impact of sarcopenia in patients undergoing transjugular intrahepatic portosystemic shunt (TIPSS) insertion for refractory ascites is unknown. MethodsAll adult patients who underwent TIPSS insertion for refractory ascites between 2010 and 2018 were included. Skeletal muscle index at L3 was used to determine sarcopenia status. Results107 patients were followed for 14.2 months. Sarcopenia was present in 57% of patients. No patient had history of pre-TIPSS hepatic encephalopathy (HE). De novo HE occurred in 30% of patients. On MVA, only platelet count and L3-SMI predicted de novo HE. On MVA, age and MELD-Na predicted mortality whereas L3-SMI and sarcopenia did not. In patients with repeat imaging, L3-SMI improved significantly post-TIPSS compared to baseline. ConclusionsSarcopenia should not be considered as a contra-indication to TIPSS insertion in refractory ascites as it is not associated with de novo HE or increased mortality.

Background and Aims: Body composition predicts mortality in patients with cirrhosis.The impact of sex on this association is unknown. We investigated the impact of sex on this association in patients with cirrhosis assessed for liver transplantation.Methods: This single-centre retrospective cohort study included adults assessed for liver transplantation. Nutritional status was assessed using the Royal Free Hospital-Global Assessment (RFH-GA). Body composition at the third lumbar vertebrae was determined. Sarcopenia SMI was defined as Skeletal Muscle Index <50 cm 2 /m 2 in males and <39 cm 2 /m 2 in females. Sarcopenia PMI was defined as the sex-specific 25th percentile of the Psoas Muscle Index. Patients were assessed for the occurrence of liver transplantation and death. Analyses were stratified by sex. Results:The cohort comprised 628 patients, including 199 females and 429 males.Both groups were similar in terms of baseline liver disease severity by Model for Endstage Liver Disease (MELD) (p = .98) and nutritional status (p = .24). Sarcopenia SMI was present in 41% of males compared to 27% of females (p < .001). In the male cohort, when adjusted for age and MELD, sarcopenia PMI (aHR 1.74, 95% CI 1.08-2.80) and RFH-GA (aHR 1.40, 95% CI 1.03-1.90) remained independent predictors of mortality.Adipose tissue had no impact on outcomes in males. In female patients, adipose tissue (TATI or VATI depending on the multivariable model) was independently associated with mortality, whereas sarcopenia and malnutrition were not. Conclusions:This study demonstrates that male patients were susceptible to low muscle mass, whereas female patients were not. Future research in this patient population should minimize sex-related bias and present data for both groups separately.

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