Background and Aim Pre-transplant sarcopenia (reduced skeletal muscle mass) predicts poor outcome in cirrhosis. In contrast, whether muscle mass increases post orthotopic liver transplantation (OLT) is not known and was studied prospectively. Methods Consecutive patients who underwent a comprehensive nutritional evaluation in a liver transplant nutrition clinic were included. Core abdominal muscle area was measured on abdominal CT obtained pre- and post-OLT. Age and gender based controls were used to define sarcopenia. Measures of body composition pre-transplant were correlated with CT measurements. Predictors and clinical impact of post-OLT change in muscle area were examined. In 3 subjects post-OLT and 3 controls, expression of genes regulating skeletal muscle mass were quantified. Results During the study period, 53 patients (M:F 41:12; age 56.9±7.5 years) were followed up after OLT for 19.3±9 months. Five patients died and another 5 had acute graft rejection. Pre-OLT sarcopenia was present in 33 (66.2%). Pre-transplant clinical characteristics including Child’s score, MELD score and nutritional status or post transplantation immunosuppression regimen did not predict post transplant change in muscle mass. New onset post-OLT sarcopenia developed in 14 patients. Loss of muscle mass post-OLT increased risk of diabetes mellitus and a trend towards higher mortality. Skeletal muscle expression of myostatin was higher and that of ubiquitin proteasome proteolytic components lower post-OLT than in controls. Conclusions Post transplantation sarcopenia is common and could not be attributed to pre-transplant characteristics or the type or duration of post-OLT immunosuppression. Post-transplant sarcopenia contributes to adverse consequences and strategies targeting myostatin may be beneficial.

TIPS reverses sarcopenia in cirrhotic patients. Failure to improve muscle area after TIPS was accompanied by a higher mortality.

Assessment of metastatic RCC target lesions on CECT for changes in morphology, attenuation, size, and structure by MASS Criteria is more accurate than response assessment by SACT Criteria, RECIST, or modified Choi Criteria. Furthermore, the use of MASS Criteria for imaging response assessment showed high interobserver agreement and may predict disease outcome in patients with metastatic RCC on targeted therapy.

Objectively measuring changes in both tumor size and attenuation on the first CECT study after initiating targeted therapy for metastatic RCC markedly improves response assessment. Distinct patterns of disease recurrence are seen in patients with metastatic RCC on targeted therapy.

Although the malignancy rate in surgically excised Bosniak IIF and Bosniak III cystic renal lesions was 25% and 54%, respectively, in our study, the malignancy rate was higher in patients with a history of primary renal malignancy or coexisting Bosniak IV lesion and/or solid renal neoplasm.