Serial Observations of Muscle and Fat Mass as Prognostic Factors for Deceased Donor Liver Transplantation

• Published in: Korean journal of radiology Vol. 22; no. 2; pp. 189 - 197
• Main Authors: Lee, Jisun, Jeong, Woo Kyoung, Kim, Jae Hun, Kim, Jong Man, Kim, Tae Yeob, Choi, Gyu Seong, Kwon, Choon Hyuck David, Joh, Jae Won, Eom, Sang Yong
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Radiology 01-02-2021; 대한영상의학회
• Subjects: Abdomen; Abdomen - diagnostic imaging; Adipose Tissue - physiology; Adult; Age; Automation; Body composition; Body Composition - physiology; Body mass index; End Stage Liver Disease - mortality; End Stage Liver Disease - pathology; End Stage Liver Disease - therapy; Female; Gastrointestinal Imaging; Humans; Laboratories; Liver diseases; Liver Transplantation; Living Donors; Male; Medical imaging; Medical prognosis; Middle Aged; Mortality; Muscle, Skeletal - physiology; Musculoskeletal system; Nutritional status; Patients; Preoperative Period; Prognosis; Proportional Hazards Models; Sarcopenia; Survival Rate; Tomography; Tomography, X-Ray Computed; Transplants & implants; 방사선과학; Preoperative period; Sarcopenia; Computed tomography; Survival; Liver transplantation
• ISSN: 1229-6929; 2005-8330
• DOI: 10.3348/kjr.2019.0750

Muscle depletion in patients undergoing liver transplantation affects the recipients' prognosis and therefore cannot be overlooked. We aimed to evaluate whether changes in muscle and fat mass during the preoperative period are associated with prognosis after deceased donor liver transplantation (DDLT).
This study included 72 patients who underwent DDLT and serial computed tomography (CT) scans. Skeletal muscle index (SMI) and fat mass index (FMI) were calculated using the muscle and fat area in CT performed 1 year prior to surgery (1 yr Pre-LT), just before surgery (Pre-LT), and after transplantation (Post-LT). Simple aspects of serial changes in muscle and fat mass were analyzed during three measurement time points. The rate of preoperative changes in body composition parameters were calculated (preoperative ΔSMI [%] = [SMI at Pre-LT - SMI at 1 yr Pre-LT] / SMI at Pre-LT × 100; preoperative ΔFMI [%] = [FMI at Pre-LT - FMI at 1 yr Pre-LT] / FMI at Pre-LT × 100) and assessed for correlation with patient survival.
SMI significantly decreased during the preoperative period (mean preoperative ΔSMI, -13.04%,
< 0.001). In the multivariable analysis, preoperative ΔSMI (
= 0.016) and model for end-stage liver disease score (
= 0.011) were independent prognostic factors for overall survival. The mean survival time for patients with a threshold decrease in the preoperative ΔSMI (≤ -30%) was significantly shorter than for other patients (
= 0.007). Preoperative ΔFMI was not a prognostic factor but FMI increased during the postoperative period (
= 0.009) in all patients.
A large reduction in preoperative SMI was significantly associated with reduced survival after DDLT. Therefore, changes in muscle mass during the preoperative period can be considered as a prognostic factor for survival after DDLT.