Severe muscle depletion in patients on the liver transplant ... : Liver Transplantation (original) (raw)

Original Articles

Severe muscle depletion in patients on the liver transplant wait list: Its prevalence and independent prognostic value

Tandon, Puneeta1,2,*,†; Ney, Michael1; Irwin, Ivana2; Ma, Mang M.1,2; Gramlich, Leah1; Bain, Vincent G.1,2; Esfandiari, Nina3; Baracos, Vickie3; Montano-Loza, Aldo J.1,2; Myers, Robert P.2,4

1_Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada_

2_Liver Transplant Unit, University of Alberta, Edmonton, Alberta, Canada_

3_Department of Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada_

4_Liver Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada_

* Division of Gastroenterology and Liver Unit, University of Alberta, 130 University Campus, Edmonton, Alberta, Canada T6G 2X8

Email: [email protected]

Received 22 March 2012; Accepted 12 June 2012

Grant sponsor: Clinical Investigator Award from the Alberta Heritage Foundation for Medical Research (now Alberta Innovates–Health Solutions); Grant sponsor: New Investigator Award from the Canadian Institutes for Health Research; Grant sponsor: University of Alberta Hospital Foundation Award.

Robert P. Myers was supported by a Clinical Investigator Award from the Alberta Heritage Foundation for Medical Research (now Alberta Innovates–Health Solutions) and by a New Investigator Award from the Canadian Institutes for Health Research. Puneeta Tandon was supported by a University of Alberta Hospital Foundation Award.

† Telephone: 780-492-9844; FAX: 780-492-9873

Abstract

As detected by cross-sectional imaging, severe muscle depletion, which is termed sarcopenia, holds promise for prognostication in patients with cirrhosis. Our aims were to describe the prevalence and predictors of sarcopenia in patients with cirrhosis listed for liver transplantation (LT) and to determine its independent prognostic significance for the prediction of waiting-list mortality. Adults listed for LT who underwent abdominal computed tomography/magnetic resonance imaging within 6 weeks of activation were retrospectively identified. The exclusions were hepatocellular carcinoma, acute liver failure, prior LT, and listing for multivisceral transplantation or living related LT. Sixty percent of the 142 eligible patients were male, the median age was 53 years, and the median Model for End-Stage Liver Disease (MELD) score at listing was 15. Forty-one percent were sarcopenic; sarcopenia was more prevalent in males versus females (54% versus 21%, P < 0.001) and increased with the Child-Pugh class (10% for class A, 34% for class B, and 54% for class C, P = 0.007). Male sex, the dry-weight body mass index (BMI), and Child-Pugh class C cirrhosis (but not the MELD score) were independent predictors of sarcopenia. Sarcopenia was an independent predictor of mortality (hazard ratio = 2.36, 95% confidence interval = 1.23-4.53) after adjustments for age and MELD scores. In conclusion, sarcopenia is associated with increased waiting-list mortality and is poorly predicted by subjective nutritional assessment tools such as BMI and subjective global assessment. If this is validated in larger studies, the objective assessment of sarcopenia holds promise for prognostication in this patient population. Liver Transpl 18:1209–1216, 2012. © 2012 AASLD.