Muscle Wasting Is Not Associated With Higher Mortality After Liver Transplantation

Purpose: Muscle wasting or sarcopenia, is the deficiency in muscle mass defined as two standard deviations below the gender-specific means. Sarcopenia is associated with increased mortality in patients with cirrhosis; however, how it impacts after liver transplantation requires further study. In this study, we aimed to establish if sarcopenia predicts increased morbidity and mortality after liver transplantation in a cohort of cirrhotic patients. Methods: 133 cirrhotic patients who had a computed tomography (CT) scan at the 3rd lumbar vertebrae before liver transplantation were selected. Data were recovered from medical charts, skeletal muscle cross-sectional area was measured by CT and sarcopenia was defined using previously published gender-specific cutoffs. Results: 90 patients were males (68%), and mean age at transplantation was 55±1 years (range, 23-73 years). Cirrhosis etiology was hepatitis C (44%), alcohol (19%), autoimmune liver diseases (17%), hepatitis B (9%), hepatocellular carcinoma (7%), and others (4%). Sarcopenia was present in 51 patients (38%). Sarcopenia was significantly more frequent in male patients (49 versus 16%, P<0.001), and patients with severe ascites (45 versus 26%, P=0.02), and was associated with a higher Child-Pugh (10±0.4 versus 8±0.3 points, P=0.009), and MELD score (20±2 versus 14±2 points, P=0.008). Overall survival after liver transplantation was 93% at 1 year, and 85% at 5 years. Median survival after liver transplantation for sarcopenic patients was 10±2 years (95% CI 5.1-14.1), compared to 12±1 years (95% CI 9.3-11.2) in non-sarcopenic patients, without significant statistical difference (P=0.1). There was a trend toward a longer hospitalization after liver transplant in sarcopenic patients compared to non-sarcopenic patients (34±5 versus 24±3 days, P=0.07). In a subanalysis of the patients who had sarcopenia before the transplant, sarcopenia resolved in 22% after liver transplantation. Conclusion: Sarcopenia is present in more than one-third of patients with cirrhosis who underwent liver transplantation. Sarcopenia does not increase mortality after liver transplantation and in some cases may resolve after liver transplantation.