Adipose tissue as a predictor of morbidity and mortality in patients listed for liver transplantation
(2024) EASL congress 2024 — Location: Milan (5.June.2024)
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- Background and aims: Body composition plays a crucial role in the prognosis of liver diseases. However, recent studies have focused mainly on muscle parameters and less is known about the adipose tissue (AT) (=subcutaneous AT (SAT) and visceral AT (VAT)) in terms of prognosis. The aims of our work are to determine the impact of body composition on the morbidity/mortality of patients listed for liver transplantation (LT) and to assess the evolution of these parameters 6 months post-LT. Method: This single-center prospective observational study screened adult patients who were assessed for LT from June 2021 to October 2023. Clinical data including nutritional and functional status, radiological assessment of muscular compartment and AT were performed at baseline and 6 months post-LT. Measures were performed on abdominal CT scan at the third lumbar level (L3) using the Slice-O-Matic software. The composite outcome was defined as death and/or emergency admission to hospital. Uni- and multivariate Cox proportional hazard regressions were computed to identify predictors of morbidity and mortality. T-test investigated the evolution of variables between pre- and 6-months post-LT. Spearman correlations were also performed. Results: We included 158 patients with a mean MELD score of 16 and a mean age of 54 years. 74% were males. 124 were cirrhotic, with alcohol-related cirrhosis in 49.2 and metabolic-associated cirrhosis in 11.3%. 35.2% were listed for hepatocellular carcinoma. During the study period, 58.2% of the patients were transplanted, 63% of them being assessed at 6-month post-LT. During the follow-up, 9, 5% died while waiting for LT, all being cirrhotic. There was at least one acute admission for 28.5%. In univariate analysis, the following variables were significantly associated with the composite outcome : MELD (HR 1.15; IC 1.1–1.201; p < 0.005), liver frailty index (LFI) (HR 2.73; IC 1.688–4.408; p < 0.005)), density of SAT (HR 1.05; IC 1.028–1.072; p < 0.05)), density of VAT (VAT; HR 1.04; 1.011–1.072, p = 0.007) and muscle density (HR 0.97; 0.956–0.987; p < 0.005). In multivariate analysis, only MELD and LFI were associated with outcome (HR: 1.14; IC1.078–1.20; p < 0, 005 and HR: 2.054; IC 1.176–3.588; p = 0.01; respectively). Among body composition characteristics, density of SAT was the strongest predictive factor but didn’t reach significance (HR 1.033, p = 0.091). There was a strong correlation between density of AT and the MELD score (SAT: r = 0.598, 95% CI 0, 4747–0, 6987, p < 0.0001; VAS: r = 0.5615, 95% CI 0, 4306–0, 6692, p < 0.0001). At the 6-month post-LT, density of SAT decreased significantly (p < 0.005), while density of muscle increased (p = 0.019). Conclusion: High SAT density, compatible with tissue inflammation, is associated with complications on the LT list and improves after LT. However, the MELD score and LFI remain the most robust independent factors for morbidity/mortality.
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Lepour, M., Alicia, D., Piessevaux, H., Trefois, P., Lanthier, N., & Dahlqvist, G. (2024). Adipose tissue as a predictor of morbidity and mortality in patients listed for liver transplantation. Journal of Hepatology, 80(S1), S360-S361. https://doi.org/10.1016/s0168-8278(24)01199-1 (Original work published 2024)