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Pretransplant Sarcopenia in Patients With NASH Cirrhosis Does Not Impact Rehospitalization or Mortality

Aby, Elizabeth S. MD*; Lee, Edward MD; Saggi, Satvir S. BS; Viramontes, Matthew R. BS; Grotts, Jonathan F. MA, BS*; Agopian, Vatche G. MD; Busuttil, Ronald W. MD; Saab, Sammy MD, MPH, AGAF, FAASLD, FACG*,‡

Journal of Clinical Gastroenterology: October 2019 - Volume 53 - Issue 9 - p 680–685
doi: 10.1097/MCG.0000000000001109

Background: Malnutrition and muscle wasting are common in patients with end-stage liver disease (ESLD), yet go underdiagnosed. Frequently used indices of nutritional status, such as body mass index, are inflated in patients with ESLD due to a fluid overloaded state. Previous work has demonstrated a strong association between psoas muscle area, a surrogate for sarcopenia, and worse survival following liver transplantation; however, the impact of sarcopenia on post liver transplant outcomes in patients with nonalcoholic steatohepatitis (NASH) cirrhosis has not been evaluated.

Goals: Describe the impact of sarcopenia in patients with NASH cirrhosis on post liver transplantation outcomes, including initial hospital length of stay, rehospitalization, and survival.

Materials and Methods: A single-center, retrospective analysis was conducted of adult liver transplants performed for NASH cirrhosis between 2002 and 2015. Sarcopenia was defined by psoas area measured at the L3 vertebra from abdominal imaging within 6 months before orthotopic liver transplant (OLT).

Results: A total of 146 patients were evaluated. The mean Model for End-Stage Liver Disease score at transplant was 34.9±7.4. Sarcopenia was present in 62% of patients and was more likely in female and Hispanic patients. There were no significant differences in length of initial hospitalization following OLT, days hospitalized within the first year post-OLT, survival at 1 year, or overall survival between sarcopenic and nonsarcopenic patients.

Conclusions: Sarcopenia in patients with NASH cirrhosis and high Model for End-Stage Liver Disease scores is not associated with an increase in mortality or rehospitalization following liver transplantation; however, the study findings were limited by a small sample size.

Departments of *Medicine

Interventional Radiology

Surgery, University of California at Los Angeles, Los Angeles, CA

E.S.A.: study concept and design. E.S.A., M.R.V., and S.S.S.: acquisition of data. E.S.A., J.F.G., and S.S.S.: analysis and interpretation of data E.S.A. and S.S.S.: drafting of the manuscript. S.S.S., E.L., V.G.A., and R.W.B.: critical revision of the manuscript for important intellectual content. J.F.G.: statistical analysis. S.S.S.: administrative, technical, or material support, study supervision.

The authors declare that they have nothing to disclose.

Address correspondence to: Sammy Saab, MD, MPH, AGAF, FAASLD, FACG Pfleger Liver Institute, UCLA Medical Center, 200 Medical Plaza, Suite 214 Los Angeles, CA 90095 (e-mail:

Received March 10, 2018

Accepted July 2, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.