Bone mineral density predicts posttransplant survival among hepatocellular carcinoma liver transplant recipients

Abstract

Hepatocellular carcinoma (HCC) is a common indication for liver transplantation (LT). Recent data suggest that body composition features strongly affect post-LT mortality. We examined the impact of body composition on post-LT mortality in patients with HCC. Methods: Data on adult LT recipients who received MELD exception for HCC between 2/29/02-12/31/13 and had CT scan anytime 6 months prior to LT were reviewed (N=118). All available CT scan DICOM (Digital Imaging and Communications in Medicine) files were analyzed using a semiautomated high throughput methodology with algorithms programmed in MATLAB®. Analytic morphomics measurements including dorsal muscle group (DMG) area, visceral and subcutaneous fat and bone mineral density (BMD) were taken at the bottom of the 11th thoracic vertebral level. Results: Thirty-two patients (28%) died during the median follow up of 4.4 years. Number of HCC lesions (HR=2.72; P<0.001), BMD (HR=0.90/HU; P=0.03), pre-LT loco-regional therapy (HR=0.34; P<0.001) and donor age (HR=1.05; P<0.001) were the independent predictors of post-LT mortality. DMG area did not affect post-LT survival. Conclusion: In addition to number of HCC lesions and pre-LT loco-regional therapy, low BMD, a surrogate for bone loss rather than DMG area, was independently associated with post-LT mortality in HCC patients. Bone loss may be an early marker of deconditioning that precedes sarcopenia and may affect transplant outcomes.

Fat Accumulation, Liver Fibrosis, and Metabolic Abnormalities in Chinese Patients With Moderate/Severe Versus Mild Hepatic Steatosis

“…In this study, we used CT scan and analytic morphomics, which allow us to provide precise and detailed measurements of fat in liver, visceral, subcutaneous, and other body compartments such as muscles. We have previously shown that analytic morphomics measurements are accurate predictors of new‐onset diabetes and survival after liver transplantation, and provide important information about clinical outcomes in patients with liver disease …”

“…We have previously shown that analytic morphomics measurements are accurate predictors of new-onset diabetes and survival after liver transplantation, (24,27) and provide important information about clinical outcomes in patients with liver disease. (25,(41)(42)(43) Several studies have shown that ectopic fat deposition in the liver, skeletal muscle, and heart is a key determinant of insulin resistance. Adipose tissue is not only a site for storage of lipids, but it also secretes various hormones and cytokines involved in regulating glucose and lipid metabolism and energy homeostasis.…”

Loss of skeletal muscle mass in patients with chronic liver disease is related to decrease in bone mineral density and exercise tolerance

“…Fractures of the vertebrae and hip may have an especially detrimental effect on physical function and HRQOL . In addition, it has been suggested that BMD may influence the postoperative outcomes of liver transplantation in patients with HCC . Therefore, evaluation of patients with chronic liver disease for sarcopenia and osteoporosis may improve their postoperative prognosis and prevent the reduction of HRQOL and ADL, which are related to the healthy lifespan.…”

“…[52][53][54][55][56] In addition, it has been suggested that BMD may influence the postoperative outcomes of liver transplantation in patients with HCC. 57 Therefore, evaluation of patients with chronic liver disease for sarcopenia and osteoporosis may improve their postoperative prognosis and prevent the reduction of HRQOL and ADL, which are related to the healthy lifespan. Furthermore, the low SMI group showed a significant decrease in PeakVO 2 , which is an index of exercise tolerance reflecting overall endurance.…”

Liver transplantation for hepatocellular carcinoma - non-cancer factors and implications for improving outcome beyond standard tumor criteria

“…Apart from AFP level and MVI, sarcopenia was identified as an independent and significant promoter of HCC relapse. In series of 118 HCC LT patients, Sharma et al [74] were able to demonstrate that bone mineral density (BMD), an early predictor of sarcopenia, is an independent predictor of post-LT mortality, with HCC recurrence to be the most common cause of death. A recent metaanalysis by Chang et al [75] including 13 studies and 3111 HCC patients after curative treatments concluded that sarcopenia is correlated with both, all-cause mortality (HR = 1.95; 95%CI 1.6-2.37) and tumor recurrence (HR = 1.76; 95%CI 1.27-2.45).…”