Sarcopenia in high acuity liver transplantation: Does it predict outcomes?

Background Sarcopenia has gained momentum as a potential risk-stratification tool in liver transplantation (LT). While LT recipients recently have more advanced end-stage liver disease, the impact of sarcopenia in high acuity recipients with a high model for end-stage liver disease (MELD) score remains unclear. Methods We retrospectively assessed sarcopenia by calculating skeletal muscle index (SMI) from cross-sectional area at third lumbar vertebra (cm(2)) and height (m(2)) in 296 patients with a CT <= 30 days prior to LT. Sex-specific SMI cut-offs were developed, and its impact was assessed in patients with MELD >= 35. Results In patients with MELD >= 35 (n = 217), men with a SMI < 30 cm(2)/m(2) had significantly higher rates of bacteremia (P = .021) and a longer hospital stay (P < .001). Women with a SMI < 34 cm(2)/m(2) had a longer hospital stay (P = .032). There were no relationships between SMI and survival in men and women with MELD >= 35. Conclusions This series examined sarcopenia with a focus on high MELD patients. Although decreased SMI contributed to higher post-LT hospital stay, it did not impact patient survival, suggesting that while SMI alone may not aid in patient selection for LT, it certainly may guide perioperative care-planning in this challenging patient population.

Automated summary

This study retrospectively assessed the impact of sarcopenia in high MELD score patients undergoing liver transplantation. Lower SMI was associated with higher rates of bacteremia and longer hospital stay in male and female patients with MELD >= 35, but did not affect patient survival. The findings suggest that while SMI may not aid in patient selection for LT, it can guide perioperative care-planning in this challenging patient population.