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Transplantation. 2019 Apr 8. doi: 10.1097/TP.0000000000002741. [Epub ahead of print]

Sarcopenia Predicts Posttransplant Mortality in Acutely Ill Men Undergoing Urgent Evaluation and Liver Transplantation.

Author information

1
Department of Medicine, Division of Gastroenterology and Hepatology, University of California-San Francisco, San Francisco, CA.
2
Division of Gastroenterology, Hepatology and Nutrition and Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA.
3
Division of Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB, Canada.
4
Division of Gastroenterology and Hepatology, Mayo Clinic, Arizona, Scottsdale, AZ.
5
Department of Radiology & Biomedical Imaging, University of California-San Francisco, San Francisco, CA.

Abstract

BACKGROUND:

We examined the association between sarcopenia and posttransplant mortality in acutely ill inpatients with cirrhosis who underwent urgent liver transplantation.

METHODS:

Included were inpatients at 4 centers who were urgently listed as non-Status 1 and transplanted from 2005-17 with an abdominal computed tomography scan <90 days prior. Skeletal muscle index (SMI) = total skeletal muscle cross sectional area the L3 vertebral level, normalized to height. Cox regression associated SMI with posttransplant mortality. Optimal search identified SMI cutoffs to detect survival.

RESULTS:

Of 126 inpatients: 63% were male, MELD-Na was 32, and follow up was 5.1 years. Among men: 23% died. Median SMI was lower in men who died versus survived (45 versus 51 cm/m). SMI was associated with posttransplant mortality (HR=0.96 per cm/m, 95%CI 0.92-0.99). Patients with SMI ≤ versus >48 cm/m experienced higher rates of death at 1- (86% versus 95%) and 3-years (73% versus 95%) (logrank P = 0.01). In MELD-adjusted analysis, sarcopenia was strongly associated with posttransplant mortality (HR=4.39, 95%CI 1.49-12.97).Among women: 35% died. Median SMI was similar in women who died versus survived (45 versus 44 cm/m). SMI was not associated with posttransplant mortality (HR=1.02, 95%CI 0.96-1.09). Optimal search did not identify any SMI cutoff that predicted posttransplant mortality.

CONCLUSION:

Among patients who underwent urgent inpatient evaluation and liver transplantation, we identified an SMI cut-off of 48 cm/m to predict posttransplant mortality in men. Our data support the use of SMI as a tool to capture the impact of muscle depletion on posttransplant mortality in acutely ill men with cirrhosis undergoing urgent liver transplantation.

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