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 (cm²) and height (m²) 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 cm²/m² had significantly higher rates of bacteremia (P =.021) and a longer hospital stay (P <.001). Women with a SMI < 34 cm²/m² 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.