Abstract
Body composition and myosteatosis affect clinical outcomes in orthotopic liver transplantation (OLT). Here we aimed to compare the value and limitations of various selection criteria to define pre-transplant myosteatosis in the assessment of short- and long-term outcomes following OLT. We retrospectively analyzed the data of 264 consecutive recipients who underwent deceased donor OLT at a German university medical centre. Myosteatosis was evaluated by preoperative computed-tomography-based segmentation. Patients were stratified using muscle radiation attenuation of the whole muscle area (L3Muslce-RA), psoas RA (L3Psoas-RA) and intramuscular adipose tissue content (IMAC) values. L3Muslce-RA, L3Psoas-RA and IMAC performed well without major differences and identified patients at risk for inferior outcomes in the group analysis. Quartile-based analyses, receiver operating characteristic curve and correlation analyses showed a superior association of L3Muslce-RA with perioperative outcomes when compared to L3Psoas-RA and L3IMAC. Long-term outcome did not show any major differences between the used selection criteria. This study confirms the prognostic role of myosteatosis in OLT with a particularly strong value in the perioperative phase. Although, based on our data, L3Muscle-RA might be the most suitable and recommended selection criterion to assess CT-based myosteatosis when compared to L3Psoas-RA and L3IMAC, further studies are warranted to validate these findings.
Highlights
Body composition and myosteatosis affect clinical outcomes in orthotopic liver transplantation (OLT)
Myosteatosis is typically defined by low muscle radiation attenuation (RA) values in Hounsfield units (HU), there are multiple selection criteria introduced by different groups to characterize myosteatosis and identify patient at risk, without a clear international c onsensus4,5,10
This study provides insights into the performance of various frequently adopted selection criteria of muscle radiation attenuation and myosteatosis in predicting short- and long-term outcomes following deceased donor liver transplantation
Summary
Body composition and myosteatosis affect clinical outcomes in orthotopic liver transplantation (OLT). Despite the fact that all of the above described muscle attenuation or myosteatosis selection criteria have been used in various patient cohorts, there is no clinical data directly comparing their value in the prediction of post-transplant outcomes in the setting of deceased donor OLT. In this study we aimed to comprehensively assess the performance of three frequently used selection criteria for myosteatosis (L3Muscle-RA; L3Psoas-RA; L3IMAC) in predicting post-transplant outcomes in a large European single-center cohort of adult patients undergoing deceased donor OLT
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