Sarcopenia in high acuity liver transplantation: Does it predict outcomes?

Background Sarcopenia has gained momentum as a potential risk-stratification tool in liver transplantation (LT). While LT recipients recently have more advanced end-stage liver disease, the impact of sarcopenia in high acuity recipients with a high model for end-stage liver disease (MELD) score remains unclear. Methods We retrospectively assessed sarcopenia by calculating skeletal muscle index (SMI) from cross-sectional area at third lumbar vertebra (cm(2)) and height (m(2)) in 296 patients with a CT <= 30 days prior to LT. Sex-specific SMI cut-offs were developed, and its impact was assessed in patients with MELD >= 35. Results In patients with MELD >= 35 (n = 217), men with a SMI < 30 cm(2)/m(2) had significantly higher rates of bacteremia (P = .021) and a longer hospital stay (P < .001). Women with a SMI < 34 cm(2)/m(2) had a longer hospital stay (P = .032). There were no relationships between SMI and survival in men and women with MELD >= 35. Conclusions This series examined sarcopenia with a focus on high MELD patients. Although decreased SMI contributed to higher post-LT hospital stay, it did not impact patient survival, suggesting that while SMI alone may not aid in patient selection for LT, it certainly may guide perioperative care-planning in this challenging patient population.