Severe muscle depletion in patients on the liver transplant wait list: Its prevalence and independent prognostic value

TLDR

Sarcopenia detected by imaging is a promising prognostic marker in patients with cirrhosis. The study aimed to determine the prevalence, predictors, and prognostic value of sarcopenia for waiting‑list mortality in cirrhotic patients awaiting liver transplantation. The cohort comprised adults on the liver transplant wait list who had abdominal CT/MRI within six weeks of activation, excluding those with hepatocellular carcinoma, acute liver failure, prior transplant, or non‑standard transplant indications. Among 142 patients, 41% were sarcopenic—more common in males and in advanced Child‑Pugh class—and male sex, low dry‑weight BMI, and Child‑Pugh C independently predicted sarcopenia, which in turn independently increased waiting‑list mortality (HR 2.36) after adjusting for age and MELD, underscoring the value of objective imaging assessment beyond conventional tools.

Abstract

As detected by cross-sectional imaging, severe muscle depletion, which is termed sarcopenia, holds promise for prognostication in patients with cirrhosis. Our aims were to describe the prevalence and predictors of sarcopenia in patients with cirrhosis listed for liver transplantation (LT) and to determine its independent prognostic significance for the prediction of waiting-list mortality. Adults listed for LT who underwent abdominal computed tomography/magnetic resonance imaging within 6 weeks of activation were retrospectively identified. The exclusions were hepatocellular carcinoma, acute liver failure, prior LT, and listing for multivisceral transplantation or living related LT. Sixty percent of the 142 eligible patients were male, the median age was 53 years, and the median Model for End-Stage Liver Disease (MELD) score at listing was 15. Forty-one percent were sarcopenic; sarcopenia was more prevalent in males versus females (54% versus 21%, P < 0.001) and increased with the Child-Pugh class (10% for class A, 34% for class B, and 54% for class C, P = 0.007). Male sex, the dry-weight body mass index (BMI), and Child-Pugh class C cirrhosis (but not the MELD score) were independent predictors of sarcopenia. Sarcopenia was an independent predictor of mortality (hazard ratio = 2.36, 95% confidence interval = 1.23-4.53) after adjustments for age and MELD scores. In conclusion, sarcopenia is associated with increased waiting-list mortality and is poorly predicted by subjective nutritional assessment tools such as BMI and subjective global assessment. If this is validated in larger studies, the objective assessment of sarcopenia holds promise for prognostication in this patient population.