Body Composition in Liver Transplant Patients: Long-Term Changes and Impact on Recovery Outcomes.

Pre-transplant sarcopenia was highly prevalent in end-stage liver disease patients undergoing liver transplantation.

• 61% of patients were sarcopenic prior to liver transplantation
• Sarcopenia was defined using sex-specific skeletal muscle index (L3-SMI) thresholds
• 19% had sarcopenic obesity (concurrent sarcopenia and obesity)
• 53% had BMI ≥ 25 kg/m²
• Single-center retrospective cohort of 81 adults undergoing LT between 2009 and 2015

Skeletal muscle mass (L3-SMI) declined after liver transplantation, partially recovered, but remained below pre-transplant baseline levels throughout follow-up.

• Longitudinal changes were modeled using linear mixed models
• Body composition was assessed via CT/MRI at the L3 level pre-LT and longitudinally up to 10 years post-LT
• L3-SMI declined initially post-LT, then partially recovered but did not return to baseline
• This pattern indicates that sarcopenia persists long after liver transplantation

Pre-transplant sarcopenia predicted lower post-transplant survival, whereas post-transplant sarcopenia status did not.

• Association between pre-LT sarcopenia and survival was identified through survival analysis
• Post-LT sarcopenia did not predict survival outcomes
• The cohort was followed up to 10 years post-transplantation
• Outcomes were analyzed in a single-center retrospective cohort of 81 adults

Visceral adipose tissue (VAT) increased for 2–4 years post-transplant and then declined, while subcutaneous adipose tissue (SAT) increased steadily over the follow-up period.

• VAT rose for approximately 2–4 years post-LT before declining
• SAT increased steadily throughout the post-LT follow-up period
• VAT/SAT ratio increased modestly early post-LT, then declined after approximately 4.5 years
• BMI decreased initially post-LT and then increased over time
• Fat distribution changes were modeled using linear mixed models with CT/MRI measurements at the L3 level

Higher pre-transplant VAT was associated with prolonged ICU stay after liver transplantation.

• Association was identified through Spearman correlations and survival analysis
• Pre-LT VAT area was quantified from CT/MRI at the L3 level
• This association was independent of BMI, which was noted as unreliable in end-stage liver disease for assessing adiposity

Elevated pre-transplant VAT/SAT ratio was correlated with longer both ICU and hospital stays following liver transplantation.

• Both ICU stay and total hospital stay were associated with elevated pre-LT VAT/SAT ratio
• Associations were identified using Spearman correlations
• VAT and SAT areas were quantified from CT/MRI imaging at the L3 vertebral level
• VAT has been associated with poorer cardiovascular health and survival in the background literature

BMI was considered unreliable for assessing adiposity in end-stage liver disease patients, necessitating CT/MRI-based body composition assessment.

• BMI decreased initially post-LT then increased over time, demonstrating its dynamic and potentially misleading nature in this population
• Alternative measures including L3-SMI, VAT, SAT, and VAT/SAT ratio were used instead
• Body composition was assessed via CT/MRI at the L3 vertebral level at pre-LT and longitudinally up to 10 years post-LT
• 53% of patients had BMI ≥ 25 kg/m² pre-LT, illustrating the co-existence of overweight/obesity and sarcopenia