The impact of sarcopenia on the outcome of patients with cirrhosis with and without hepatocellular carcinoma who undergo liver transplantation

Background: The impact of sarcopenia on the outcome of patients with cirrhosis who undergo liver transplantation (LT) has been analysed in heterogeneous cohorts with mixed results. We sought to determine the prevalence and the impact of pre-LT sarcopenia on morbidity and mortality after LT in a cohort of patients with cirrhosis with and without hepatocellular carcinoma (HCC).Methods: Patients with cirrhosis who underwent LT between 2010 and 2016 at Padua University Hospital were retrospectively evaluated. Using image software analysis, cross-sectional area of skeletal muscle at 3rd lumbar vertebra was measured and skeletal muscle index (SMI) was calculated. Sarcopenia was defined by SMI < 50 cm2/m2 in males and < 39 cm2/m2 in females, respectively. Primary outcome was post-LT survival. Secondary outcomes included hospitalization length and post-LT complications.Results: 197 patients were included, of whom, 122 (62%) had sarcopenia. Demographics and severity of cirrhosis were comparable in patients with vs. without sarcopenia. Overall survival was similar between the groups. When survival analysis was adjusted for severity of liver disease, sarcopenia was associated with a significantly reduced survival in decompensated (80% vs. 91%, 1-year post-LT; P = 0.04) but not in compensated (93% vs. 90%, 1-year post-LT; P = 0.7) patients. In patients with HCC, sarcopenia was associated with a trend towards lower survival but only in those with HCC beyond Milan criteria. Among secondary outcomes, bacterial infections were more frequent in patients with vs. without sarcopenia (50% vs. 35%; P = 0.02), whereas hospitalization length and other complications were comparable between the groups.Conclusion: Sarcopenia is a common finding in patients awaiting LT and, in those with decompensated cirrhosis, it is associated with reduced survival after transplantation