The evolution of the muscle compartment from the listing to six-month post-transplantation : a longitudinal monocentric study.
(2023) EASL congress 2023 — Location: Vienna (21.June.2023)
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- Background and aims: Body composition of the cirrhotic patient plays an important role in his prognosis. Skeletal muscle mass (sarcopenia), malnutrition, frailty (liver frailty index LFI) and myosteatosis are associated with worse outcome in cirrhotic patients. The aim of this study was to determine the best muscle-related predictor of morbidity and mortality on the waiting list and after LT and to evaluate the evolution of all muscle-related parameters up to six months post-transplant. Method: This single-center prospective observational study screened adult patients who were candidates for liver transplantation from June 2021 to September 2022. Each candidate received a functional and nutritional assessment during its pre-transplant evaluation. Muscle quantity and quality were assessed using an abdominal CT scan at the third lumbar level (L3). Sarcopenia was defined as skeletal muscle mass index (SMI) <39 cm2/m2 in females and <50 cm2/m2 in males. Myosteatosis was assessed by skeletal muscle radiodensity attenuation (SM-RA), with cut-offs of SM-RA <41 HU for patients with a BMI <24.9 kg/m2 and <33 HU for patients with a BMI ≥25 kg/ m2. Frailty was defined using the Liver Frailty Index (LFI). Time-to- event analysis was performed using Kaplan-Meier method to investigate the impact of functional variables on outcome. One-year survival was determined for patients who underwent liver transplant during this period. Univariate and multivariate Cox proportional hazard regressions were computed to identify predictors of morbid- ity and mortality on the waiting list for LT. Results: 103 patients were screened, 84 were placed on the Eurotransplant LT waiting list and 49 were transplanted during the study period. The mean age was 54 years and 67.7% were males. The primary etiology of liver disease was alcohol and 38% had a hepatocellular carcinoma. The one-year patient survival probability on the waiting list was 76.9 ± 7.2%. This probability was significantly reduced in patients with myosteatosis compared with patients with higher SM-RA values (43 ± 17% vs 95 ± 4%, p < 0.001). Compared with other muscle characteristics, myosteatosis was the strongest predict- ive factor of mortality. 28 patients had a full 6-months post-LT assessment. Of those liver transplanted patients, 57.7% were frail and 40.7% had myosteatosis before LT. At 6 months post-LT, 53.8% were frail and only 25% had myosteatosis. SMI was not different before and after LT. Compared with pre-LT data, muscle density increased with a mean delta of 4.6 HU ( p = 0.06) (Figure). The 5 chairs stand test significantly improved after LT (11.6 sec vs 9.0 sec ( p = 0.013). The other parameters (handgrip, LFI, ...) remained stable. Conclusion: Myosteatosis is significantly associated with negative pre-transplant outcomes. After LT, patients improve in muscle strength but not in muscle quantity or quality evaluated by CT-scan.
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Delorme, A., Goffaux, A., De Azevedo Coutinho Pereira, D., Dumont, C., Philippart, M., Henin, G., Braem Frédéric, Ciccarelli, O., Trefois Pierre, Lanthier, N., & Dahlqvist, G. (2023). The evolution of the muscle compartment from the listing to six-month post-transplantation : a longitudinal monocentric study. Journal of Hepatology, 78(Suppl. 1), S464-S465. https://hdl.handle.net/2078.5/29448 (Original work published 2023)