Muscle mass predicts outcomes following liver transplantation

Abstract

Background and aims For patients with end-stage liver disease commonly used indices of nutritional status (i.e. body weight and BMI) are often inflated due to fluid overload (i.e. ascites, peripheral edema) resulting in an underdiagnosis of malnutrition. As muscle is the largest protein reservoir in the body, an estimate of muscle mass may be a more reliable and valid estimate of nutritional status. Methods Therefore, we used pre-transplant computerized tomography data of 338 liver transplant (LTX) candidates to identify muscle and fat mass based on a specific abdominal transverse section commonly used in body composition analyses and investigated the contribution of this measure to specific post-LTX outcomes. Results We found the majority, 68%, of our patients could be defined as cachetic. For men muscle mass predicted many important post-transplant outcomes including intensive care unit (ICU) and total length of stay and days of intubation. Muscle mass was a significant predictor of survival and also predicted disposition to home vs another facility. For women muscle mass predicted lengths of ICU and total stay and days of intubation but the effect was modest. Muscle mass did not predict survival or disposition for women. Conclusions As pre-transplant muscle mass was associated with many important post-operative outcomes we discuss these findings in the context of possible pre-transplant interventions to either improve or sustain muscle mass before surgery.

Systematic Review and Meta-Analysis of the Impact of Computed Tomography–Assessed Skeletal Muscle Mass on Outcome in Patients Awaiting or Undergoing Liver Transplantation

“…The prevalence greatly depended on the definition used. All studies that reported the prevalence of sarcopenia separately for males and females reported a higher prevalence among males (12,14,17,(21)(22)(23)(24)(25)(26)30).…”

“…From these 28 records, eight studies assessed muscle mass with means other than CT and one study was performed in a population other than patients awaiting or undergoing liver transplantation. The remaining 19 studies, including 3803 patients in partly overlapping cohorts, were included in this systematic review (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Cross-referencing yielded no additional records.…”

“…The methods of muscle measurement and sarcopenia definitions that were used are summarized in Table 2. Nine studies reported the cross-sectional muscle area with corresponding skeletal muscle index (12)(13)(14)17,(22)(23)(24)(25)30), whereas the psoas area was reported in eight studies (15,16,18,19,21,(26)(27)(28) and the dorsal muscle group area was reported in one study (20). One study calculated the morphometric age (calculated with total psoas area, psoas density, and abdominal aortic calcifications) (29).…”

“…The mean skeletal muscle index ranged from 43.0 to 54.3 cm²/m² (13,30). The prevalence of sarcopenia was reported in 17 studies (12)(13)(14)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)30) and ranged from 22.2% (30) to nearly 70% (13). The prevalence greatly depended on the definition used.…”

Reply

“…1 We also hypothesized that testosterone could be a reason for our finding that muscle mass was associated with mortality in men but not in women. Having demonstrated in their own work an association between testosterone and mortality in liver disease, Grossmann et al bring these issues more to light.…”