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Sarcopenia Predicts Post-transplant Mortality in Acutely Ill Men Undergoing Urgent Evaluation and Liver Transplantation

Kuo, Selena Z. MD1; Ahmad, Myra BS1; Dunn, Michael A. MD2; Montano-Loza, Aldo J. MD, PhD3; Carey, Elizabeth J. MD4; Lin, Shezhang MD5; Moghe, Akshata MD, PhD2; Chen, Hui-Wei MD2; Ebadi, Maryam PhD3; Lai, Jennifer C. MD, MBA1

doi: 10.1097/TP.0000000000002741
Original Clinical Science–Liver
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Background. We examined the association between sarcopenia and post-transplant mortality in acutely ill inpatients with cirrhosis who underwent urgent liver transplantation.

Methods. Included were inpatients at 4 centers who were urgently listed as nonstatus 1 and transplanted from 2005 to 2017 with an abdominal computed tomography scan <90 days before transplantation. Skeletal muscle index (SMI) = total skeletal muscle cross-sectional area at the L3 vertebral level, normalized to height. Cox regression associated SMI with post-transplant mortality. Optimal search identified SMI cutoffs to detect survival.

Results. Of 126 inpatients, 63% were male patients, model for end-stage liver disease (MELDNa) 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 cm2/m2). SMI was associated with post-transplant mortality (hazard ratio [HR] = 0.96 per cm2/m2, 95% CI 0.92-0.99). Patients with SMI ≤ 48 cm2/m2 versus >48 cm2/m2 experienced higher rates of death at 1 year (86% versus 95%) and 3 years (73% versus 95%) (Log-rank P = 0.01). In MELD-adjusted analysis, sarcopenia was strongly associated with post-transplant 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 cm2/m2). SMI was not associated with post-transplant mortality (HR = 1.02, 95% CI 0.96-1.09). Optimal search did not identify any SMI cutoff that predicted post-transplant mortality.

Conclusions. Among patients who underwent urgent inpatient evaluation and liver transplantation, we identified an SMI cutoff value of 48 cm2/m2 to predict post-transplant mortality in men. Our data support the use of SMI as a tool to capture the impact of muscle depletion on post-transplant mortality in acutely ill men with cirrhosis undergoing urgent liver transplantation.

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.

Received 14 November 2018. Revision received 14 February 2019.

Accepted 15 March 2019.

This study was funded by K23AG048337 (Paul B. Beeson Career Development Award in Aging Research). These funding agencies played no role in the analysis of the data or the preparation of this article.

The authors declare no conflicts of interest.

S.Z.K participated in study concept and design, acquisition of data, analysis and interpretation of data, drafting of the article, and statistical analysis. M.A. participated in study concept and design, acquisition of data, analysis and interpretation of data, drafting of the article, and statistical analysis. M.A.D. participated in study concept and design, acquisition of data, analysis and interpretation of data, critical revision of the article for important intellectual content, and study supervision. A.J.M.-L. participated in study concept and design, acquisition of data, analysis and interpretation of data, critical revision of the article for important intellectual content, and study supervision. E.J.C. participated in study concept and design, acquisition of data, analysis and interpretation of data, critical revision of the article for important intellectual content, and study supervision. S.L. participated in acquisition of data, critical revision of the article for important intellectual content. A.M. participated in acquisition of data, critical revision of the article for important intellectual content. H.W.C. participated in acquisition of data, critical revision of the article for important intellectual content. M.E. participated in acquisition of data, critical revision of the article for important intellectual content. J.C.L. participated in study concept and design, acquisition of data, analysis and interpretation of data, drafting of the article, critical revision of the article for important intellectual content, statistical analysis, obtained funding, and study supervision. S.Z.K. and M.A. are the co-first authors of this work.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Correspondence: Jennifer C. Lai, MD, MBA, 513 Parnassus Ave, UCSF Box 0538, San Francisco, CA 94143. (Jennifer.lai@ucsf.edu).

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