Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Preoperative Assessment of Muscle Mass Using Computerized Tomography Scans to Predict Outcomes Following Orthotopic Liver Transplantation

Esser, Hannah MD1; Resch, Thomas MD, PhD1; Pamminger, Mathias MD2; Mutschlechner, Beatrix MD1; Troppmair, Jakob MSc, PhD1; Riedmann, Marina Lic Math3; Gassner, Eva MD2; Maglione, Manuel MD1; Margreiter, Christian MD1; Boesmueller, Claudia MD1; Oberhuber, Rupert MD, PhD1; Weissenbacher, Annemarie MD, PhD1; Cardini, Benno MD1; Finkenstedt, Armin MD4; Zoller, Heinz MD4; Tilg, Herbert MD4; Öfner, Dietmar MD, MSc1; Schneeberger, Stefan MD1

doi: 10.1097/TP.0000000000002759
Original Clinical Science—Liver

Background. Sarcopenia is an established risk factor predicting survival in chronically ill and trauma patients. We herein examine the assessment and clinical implication of sarcopenia in liver transplantation (LT).

Methods. Computerized tomography scans from 172 patients waitlisted for LT were analyzed by applying 6 morphometric muscle scores, including 2 density indices (psoas density [PD] and skeletal muscle density [SMD]) and 4 scores based on muscle area (total psoas area, psoas muscle index, skeletal muscle area, and skeletal muscle index).

Results. The prevalence of sarcopenia in our cohort ranged from 7.0% to 37.8%, depending on the score applied. Only sarcopenia as defined by the density indices PD and SMD (but not total psoas area, psoas muscle index, skeletal muscle area, or skeletal muscle index) revealed clinical relevance since it correlates significantly with postoperative complications (≥Grade III, Clavien-Dindo classification) and sepsis. Furthermore, sarcopenia predicted inferior patient and graft survival, with low muscle density (PD: <38.5 HU or SMD: <30 HU) representing an independent risk factor in a multivariate regression model (P < 0.05). Importantly, the widely used Eurotransplant donor risk index had a predictive value in nonsarcopenic patients but failed to predict graft survival in patients with sarcopenia.

Conclusions. Sarcopenia revealed by low muscle density correlates with major complications following LT and acts as an independent predictor for patient and graft survival. Therefore, the application of a simple computerized tomography-morphologic index can refine an individual recipient’s risk estimate in a personalized approach to transplantation.

1 Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Austria.

2 Department of Radiology, Medical University of Innsbruck, Austria.

3 Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Austria.

4 Department of Internal Medicine I, Medical University of Innsbruck, Austria.

Received 29 October 2018. Revision received 5 March 2019.

Accepted 25 March 2019.

The authors declare no funding or conflicts of interest.

H.E., T.R., B.M., and M.R. retrieved and analyzed data. M.P. and E.G. performed the radiologic evaluation of CT scans. H.E., T.R., and S.S. contributed to the design of the study and the writing of the article. M.M., J.T., C.M., C.B., R.O., A.W., B.C., A.F., H.Z., H.T., and D.Ö. provided advice and discussions. All authors reviewed the article before submission. H.E. and T.R. contributed equally to 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 (

Address for Correspondence: Hannah Esser, Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. (

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