No abstract

epatocellular carcinoma (HCC) is the most common primary liver malignancy and the second-most common cause of cancer-related death worldwide (1,2). For patients with stage T2 HCC who are not candidates for surgical resection, liver transplantation offers the best chance for disease-free survival (3). The limited availability of donor organs and increasing demand for these organs result in long waiting-list times, during which many patients become ineligible for transplantation because of tumor progression beyond stage T2 (4). This has prompted the widespread use of local-regional bridging therapies such as percutaneous ablation, transcatheter bland arterial embolization, chemoembolization, radioembolization, and radiation therapy to maintain a patient's eligibility for transplantation (5,6). The Liver Imaging Reporting and Data System (LI-RADS) is a system of standardized imaging criteria developed for the evaluation of patients at risk of developing HCC. The 2017 version of LI-RADS introduced a Treatment Response (LI-RADS Treatment Response [LR-TR]) algorithm for the assessment of lesions that have been previously treated with local-regional therapies (7,8). These lesions are categorized as LR-TR Nonviable, Equivocal, or Viable according to their imaging features, including focal arterial phase hyperenhancement (APHE), washout, and enhancement similar to pretreatment enhancement (9). While similar to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) (10), the LR-TR algorithm clarifies tumor status at the level of individual lesions, rather than making an overall categorization of disease burden (11). However, there are currently no published data that evaluate the performance of the Treatment Response algorithm for predicting the degree of local-regional

The aim of this study is to validate a proposed definition of sarcopenia in predicting wait‐list mortality. We retrospectively evaluated 355 adults (age ≥18 years) with cirrhosis listed for first‐time LT from January 1, 2010, to April 1, 2018 from our center. Demographic, laboratory, and outcome data were collected in conjunction with computed tomography scans performed within 3 months of listing. Using imaging analysis software, the skeletal muscle index (SMI), which is a marker for sarcopenia‐related mortality, was calculated. A survival analysis was performed to evaluate the association of the proposed sarcopenia definition of SMI <50 cm2/m2 for men or <39 cm2/m2 for women with wait‐list mortality or delisting. Median SMI was 54.1 cm2/m2 (range, 47‐60 cm2/m2). A total of 61 (17.2%) patients exhibited sarcopenia according to the proposed threshold, and 24.6% (57/232) of men were sarcopenic compared with 3.3% (4/123) of women (P < 0.001). Mean (standard deviation [SD]) SMI was also higher for men (56.6 ± 9.6 cm2/m2) than for women (50.7 ± 8.0 cm2/m2; P < 0.001). Median follow‐up time among patients was 2.1 months (0‐12 months), and 30 events were observed (hazard ratio, 0.98; 95% confidence interval, 0.95‐1.02; P = 0.41). There was no statistically significant difference in time on the waiting list between patients with and without sarcopenia (P = 0.89) as defined at the threshold. Using the prespecified definitions of sarcopenia based on SMI, there was no statistically significant difference in mortality and delisting from the transplant waiting list between patients with and without sarcopenia in this population. Practice and region‐specific patterns for pretransplant selection and median Model for End‐Stage Liver Disease at transplant may affect SMI as a predictor of wait‐list mortality.