Body fat composition determines outcomes before and after liver transplantation in patients with cirrhosis

Abstract

Cachexia occurs in late stages of liver cirrhosis, and a low-fat mass is potentially associated with poor outcome. This study compared different computed tomography (CT)-derived fat parameters with respect to its prognostic impact on the development of complications and death before and after liver transplantation. Between 2001 and 2014, 612 patients with liver cirrhosis without hepatocellular carcinoma listed for liver transplantation met the inclusion criteria, including abdominal CT scan (±200 days to listing). A total of 109 patients without cirrhosis served as controls. The subcutaneous fat index (SCFI), the paraspinal muscle fat index, and the visceral fat index were assessed at L3/L4 level and normalized to the height (cm 2 /m 2 ). Data were collected and analyzed retrospectively. Low SCFI was associated with a higher rate of ascites and increased C-reactive protein levels (p < 0.001). In addition, multivariate Cox regression analysis adjusting for sex, age, body mass index (BMI), and Model for End-Stage Liver Disease showed that decreasing SCFI was also associated with an increased risk of cirrhosis-related complications (p = 0.003) and death on the transplant wait list (p = 0.013). Increased paraspinal and visceral fat were not only positively correlated with creatinine levels (p < 0.001), BMI, and metabolic comorbidities (all p < 0.001) before transplantation, but also predictive for 1-year mortality after transplantation. Conclusion:The distribution of body fat is a major determinant for complications and outcome in cirrhosis before and after liver transplantation.

Impact of sarcopenia on the survival of patients undergoing liver transplantation for decompensated liver cirrhosis

“…Cachexia is the ongoing loss of body composition (skeletal muscle or fat mass), leading to progressive functional impairment. Muscle wasting is a well‐known phenomenon associated with decompensated cirrhosis, 32 and body fat distribution is also a marker of outcome in patients with liver cirrhosis after LT. An observational study found that lower visceral fat mass (HR: 1.403, 95% CI, 1.057–1.862, P = 0.019) significantly reduced the 1‐year OS after LT in patients with liver cirrhosis 33 . Unintentional weight loss is one of five domains of the Fried frailty phenotype 34 .…”

Body composition is associated with disease aetiology and prognosis in patients undergoing resection of intrahepatic cholangiocarcinoma

“…The adaptation to BMI is based on the fact that an accumulation of inter‐ and intramyocellular fat is significantly dependent on the overall amount of body fat and can only be considered pathological in the context of BMI. A visceral fat area (VFA) exceeding 100 cm 2 indicated visceral obesity, 19 while the SFI was dichotomized at the upper tertile of the cohort (71.89 cm 2 /m 2 ) 23 . Sarcopenic obesity was defined as sarcopenia plus a simultaneous BMI ≥25 kg/m 2 9 …”

Metabolic and histomorphological changes of adipose tissue in cachexia

“…In other catabolic diseases, the data on body composition (in particular, adipose tissue), malnutrition and survival are still scanty. However, in selected populations, such as those with liver cirrhosis in wait list for transplantation, often affected by poor nutritional status, low SAT was associated with increased inflammation, decompensated cirrhosis and with increased risk of complications and death on transplant wait list, whereas increased visceral fat was a predictor of 1-year mortality after transplantation [45]. Also, Zhu et al [46] found that modifications of SAT negatively affected clinical outcomes in cirrhosis.…”