Relevance of Adipose Tissue Accumulation and Muscularity in Patients Undergoing Liver Resection

Abstract

Introduction: Nutritional status is known to affect the quality of liver parenchyma. This study aimed to evaluate the relevance of the amount of adipose and muscular tissue assessed on computed tomography (CT) in patients undergoing liver resection. Methods: In this prospective observational study, 64 patients undergoing liver resection underwent preoperative CT assessment of height-normalized amount of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and total adipose tissue (TAT), smooth muscle (SM) and psoas muscle (PM). The primary outcome measure was early injury and function of remnant liver, as reflected by immediate (within 24 hours) and peak serum transaminases activity, international normalized ratio (INR), and bilirubin concentration. Results: Median SAT, VAT, TAT, SM, and PM were 65.4, 41.0, 115.1, 47.8, and 5.9 cm2/m2, respectively. TAT was significantly correlated with macro- (R=0.43; p=0.001) and microvesicular (R=0.36; p=0.007) liver steatosis, with stronger impact of subcutaneous than visceral fat. In patients undergoing minor resections (n=29), SM was positively correlated with early (R=0.53; p=0.004) and peak (R=0.43; p=0.020) bilirubin and SAT (R=0.43; p=0.031), VAT (R=0.51; p=0.007), and TAT (R=0.50; p=0.010) were positively correlated with early INR. Interestingly, in patients without relevant liver steatosis (< 30%), SAT (R=0.48; p=0.034) was additionally positively correlated with early aspartate transaminase activity and VAT (R=0.48; p=0.029) and TAT (R=0.55; p=0.010) with peak aspartate transaminase activity. Conclusion: Excessive amount of adipose tissue exacerbates injury and negatively influences early liver remnant function after minor liver resections. Increased muscularity may lead to increased bilirubin concentrations of undetermined clinical significance.