The role of recipient myosteatosis in graft and patient survival after deceased donor liver transplantation

Abstract

Background Myosteatosis is associated with perioperative outcomes in orthotopic liver transplantation (OLT). Here, we investigated the effects of body composition and myosteatosis on long-term graft and patient survival following OLT. Methods Clinical data from 225 consecutive OLT recipients from a prospective database were retrospectively analysed (May 2010 to December 2017). Computed tomography-based lumbar skeletal muscle index (SMI) (muscle mass) and mean skeletal muscle radiation attenuation (SM-RA) (myosteatosis) were calculated using a segmentation tool (3D Slicer). Patients with low skeletal muscle mass (low SMI) and myosteatosis (low SM-RA) were identified using predefined and validated cut-off values. Results The mean donor and recipient age was 55 ± 16 and 54 ± 12 years, respectively. Some 67% of the recipients were male. The probability of graft and patient survival was significantly lower in patients with myosteatosis compared with patients with higher SM-RA values (P = 0.011 and P = 0.001, respectively). Low skeletal muscle mass alone was not associated with graft and patient survival (P = 0.273 and P = 0.278, respectively). Dividing the cohort into quartiles, based on the values of SMI and SM-RA, resulted in significant differences in patient but not in graft survival (P = 0.011). Even though multivariable analysis identified low SM-RA as an important prognostic marker (hazard ratio: 2.260, 95% confidence interval: 1.177-4.340, P = 0.014), myosteatosis lost its significance when early mortality (90 days) was excluded from the final multivariable model. Patients with myosteatosis showed significantly higher all-cause mortality and in particular higher rates of deaths due to respiratory and septic complication (P = 0.002, P = 0.022, and P = 0.049, respectively). Conclusions Preoperative myosteatosis may be an important prognostic marker in patients undergoing deceased donor liver transplantation. The prognostic value of myosteatosis seems to be particularly important in the early post-operative phase. Validation in prospective clinical trials is warranted.

Myosteatosis as an independent risk factor for mortality after kidney allograft transplantation: a retrospective cohort study

“…The different pre-existing low-MD cut-offs established in the literature are not adapted to our population. Indeed, using the same cut-off points for the definition of myosteatosis as used in the liver transplant cohort and in previous studies 13,25 (i.e. a mean MD < 41 HU for patients with a BMI up to 24.9 kg/m 2 and <33 HU for patients with a BMI ≥ 25 kg/m 2 ), up to 90% (N = 171/200) of KTr would have been considered to have myosteatosis.…”

Various myosteatosis selection criteria and their value in the assessment of short- and long-term outcomes following liver transplantation

“…Briefly, image data of the most recent preoperative CT-scan were analyzed by the same investigator who was blinded for the remaining clinical data and outcomes of the patients. A single cross-sectional image/patient has been analyzed at the level of the third lumbar vertebra using the 3D Slicer software platform version 4.1 and BC module ( https://www.slicer.org/ ) as described before 4 , 13 , 14 . Table 1 shows the definitions and attenuation cutoff values used in the segmentation analysis.…”

Defining sarcopenia and myosteatosis: the necessity for consensus on a technical standard and standardized cut‐off values

“…To date, there is still no consensus on standardized CT-derived cut-off values for low skeletal muscle mass and myosteatosis, which impairs accurate data analysis, interpretation, and subsequent translation to clinical practice. Although some studies have presented cut-off values for low muscle mass [2][3][4][5][6][7] and low muscle density, 8,9 discrepancies exist between these cut-off values due to differences in characteristics of the study population or the techniques used to assess quantity and quality of muscle mass, forcing researchers and clinicians to continue determining cut-off values specific to their study population. Morel et al made use of age-specific and sex-specific normality thresholds of 130 healthy subjects and used a standardized procedure for their CT examinations.…”