Impact of sarcopenia on the survival of patients undergoing liver transplantation for decompensated liver cirrhosis.

Abstract

Patients with decompensated cirrhosis (DC) are prone to skeletal muscle loss, namely, sarcopenia, before liver transplantation (LT). While sarcopenia is reportedly associated with adverse outcomes after LT, these findings are limited owing to mixed diseases and retrospective data. We investigated the association between sarcopenia and 1-year overall survival (OS) in patients with DC after LT and established and validated a prediction model for postoperative OS based on sarcopenia. Overall, 222 consecutive patients who underwent LT at our centre were registered between September 2020 and June 2022. Third lumbar spine skeletal muscle mass index was measured using computed tomography. Patients were divided into sarcopenia and non-sarcopenia groups according to the skeletal muscle mass index, and baseline data and postoperative outcomes were collected, compared and analysed. The primary outcome was the 1-year OS after LT. We established a dynamic nomogram of the OS predictive model. We included 177DC patients [mean (standard deviation) age, 50.2±9.3years; 52 women (29.4%)]; 73 (41.2%) had sarcopenia. The mean (standard deviation) body mass index was 22.6±4.5kg/m2 , 28 (15.8%) patients had weight loss ≥5% within 6months before admission, and the mean (standard deviation) model for end-stage liver disease (MELD) score was 18.4±7.9. Patients with sarcopenia had a longer duration of intensive care unit stay (4.1±2.2 vs. 3.1±1.1days, P=0.008), higher rate of major complications (45.2% vs. 22.1%, P=0.001) and higher postoperative mortality (15.1% vs. 2.9%, P=0.003) than those without sarcopenia. The median 1-year OS after surgery was shorter in patients with sarcopenia than in those without (P<0.001). Sarcopenia [hazard ratio (HR), 2.54; 95% confidence interval (CI), 1.54-5.63; P=0.022], weight loss ≥5% (HR, 2.46; 95% CI, 1.39-5.09; P=0.015) and MELD score (HR, 1.05; 95% CI, 1.01-1.09; P=0.009) were independent risk factors associated with 1-year OS. The area under the curve of the established dynamic nomogram was 0.774, the calibration curve showed good consistency, and analysis of the decision curve showed more clinical benefits than the MELD score alone. High-risk patients (>102.9 points calculated using the nomogram) had a significantly reduced survival rate. Sarcopenia is associated with adverse outcomes after LT in patients with DC. High-risk patients should be classified by dynamic nomogram upon admission.