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

Abstract

Body composition and myosteatosis affect clinical outcomes in orthotopic liver transplantation (OLT). Here we aimed to compare the value and limitations of various selection criteria to define pre-transplant myosteatosis in the assessment of short- and long-term outcomes following OLT. We retrospectively analyzed the data of 264 consecutive recipients who underwent deceased donor OLT at a German university medical centre. Myosteatosis was evaluated by preoperative computed-tomography-based segmentation. Patients were stratified using muscle radiation attenuation of the whole muscle area (L3Muslce-RA), psoas RA (L3Psoas-RA) and intramuscular adipose tissue content (IMAC) values. L3Muslce-RA, L3Psoas-RA and IMAC performed well without major differences and identified patients at risk for inferior outcomes in the group analysis. Quartile-based analyses, receiver operating characteristic curve and correlation analyses showed a superior association of L3Muslce-RA with perioperative outcomes when compared to L3Psoas-RA and L3IMAC. Long-term outcome did not show any major differences between the used selection criteria. This study confirms the prognostic role of myosteatosis in OLT with a particularly strong value in the perioperative phase. Although, based on our data, L3Muscle-RA might be the most suitable and recommended selection criterion to assess CT-based myosteatosis when compared to L3Psoas-RA and L3IMAC, further studies are warranted to validate these findings.

Body fat composition determines outcomes before and after liver transplantation in patients with cirrhosis

“…[ 21 ] Recently two other studies evaluated fat mass and myosteatosis at L3 in especially the perioperative setting, implying that at the timepoint of transplantation, body composition acts as a prognostic factor. [ 22,23 ] Herein, the authors describe a poorer outcome and increased hospital and intensive‐care‐unit stay with a higher myosteatosis at the time point of transplantation. However, there was no differentiation of compartments.…”

“…[ 16 , 30 , 31 ] Further studies also describe an increased risk of death after transplantation for patients with an increased visceral‐subcutaneous fat tissue ratio, [ 32 ] an increased visceral fat area, [ 33 ] and with myosteatosis. [ 22 , 23 , 34 ] However, there are also contrary data showing that obesity does not affect survival after liver transplantation, [ 35 , 36 ] suggesting that the distinction between different fat compartments might be the clue to reliably predict patients’ outcome in different disease scenarios.…”

Myosteatosis in Cirrhosis: A Review of Diagnosis, Pathophysiological Mechanisms and Potential Interventions

“…Psoas muscle radiodensity below 43.14 HU was associated with higher 12-month mortality after adjusting for age, sex and Child–Pugh score [ 21 ]. When the predictive performance of psoas muscle radiodensity in predicting short- and long-term outcomes after deceased donor LT was compared to the performance of mean radiodensity of L3 skeletal muscle, better performance was observed using the latter in predicting post-LT mortality [ 22 ]. However, no sex-specific cutoffs using the mean radiodensity of L3-skeletal muscle have been established in patients with cirrhosis to predict pre-liver transplant (LT) mortality.…”

“…In patients receiving deceased donor orthotopic LT, mortality and complication rates over the first 3 months, length of intensive care unit (ICU) and hospital stay, and procedural costs were higher in patients with myosteatosis. There were no differences in long-term graft and patient survival between groups [ 32 , 33 ], suggesting myosteatosis is a key factor in predicting short-term outcomes following LT [ 22 ]. In another study, despite longer ICU stay in patients with cirrhosis and myosteatosis, no difference in the hospital length of stay or bacterial infections was seen in the first 90 days post-LT between the groups [ 19 ].…”

Body composition and the skeletal muscle compartment in liver transplantation: Turning challenges into opportunities

“…Besides the aforementioned SMI cutoffs, multiple other muscle area‐, thickness‐ or volume‐based indices and cutoffs for the posas or paraspinal muscles have been defined and reported by other groups (Table 2; Tables S1–S4). 29,30 …”