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Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value.

Abstract

As detected by cross-sectional imaging, severe muscle depletion, which is termed sarcopenia, holds promise for prognostication in patients with cirrhosis. Our aims were to describe the prevalence and predictors of sarcopenia in patients with cirrhosis listed for liver transplantation (LT) and to determine its independent prognostic significance for the prediction of waiting-list mortality. Adults listed for LT who underwent abdominal computed tomography/magnetic resonance imaging within 6 weeks of activation were retrospectively identified. The exclusions were hepatocellular carcinoma, acute liver failure, prior LT, and listing for multivisceral transplantation or living related LT. Sixty percent of the 142 eligible patients were male, the median age was 53 years, and the median Model for End-Stage Liver Disease (MELD) score at listing was 15. Forty-one percent were sarcopenic; sarcopenia was more prevalent in males versus females (54% versus 21%, P < 0.001) and increased with the Child-Pugh class (10% for class A, 34% for class B, and 54% for class C, P = 0.007). Male sex, the dry-weight body mass index (BMI), and Child-Pugh class C cirrhosis (but not the MELD score) were independent predictors of sarcopenia. Sarcopenia was an independent predictor of mortality (hazard ratio = 2.36, 95% confidence interval = 1.23-4.53) after adjustments for age and MELD scores. In conclusion, sarcopenia is associated with increased waiting-list mortality and is poorly predicted by subjective nutritional assessment tools such as BMI and subjective global assessment. If this is validated in larger studies, the objective assessment of sarcopenia holds promise for prognostication in this patient population.

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  • Authors+Show Affiliations

    ,

    Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada. ptandon@ualberta.ca

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    Source

    MeSH

    Body Mass Index
    Female
    Humans
    Liver Cirrhosis
    Liver Transplantation
    Male
    Middle Aged
    Predictive Value of Tests
    Prevalence
    Prognosis
    Retrospective Studies
    Sarcopenia
    Severity of Illness Index
    Sex Factors
    Survival Rate
    Waiting Lists

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22740290

    Citation

    Tandon, Puneeta, et al. "Severe Muscle Depletion in Patients On the Liver Transplant Wait List: Its Prevalence and Independent Prognostic Value." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 18, no. 10, 2012, pp. 1209-16.
    Tandon P, Ney M, Irwin I, et al. Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value. Liver Transpl. 2012;18(10):1209-16.
    Tandon, P., Ney, M., Irwin, I., Ma, M. M., Gramlich, L., Bain, V. G., ... Myers, R. P. (2012). Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 18(10), pp. 1209-16. doi:10.1002/lt.23495.
    Tandon P, et al. Severe Muscle Depletion in Patients On the Liver Transplant Wait List: Its Prevalence and Independent Prognostic Value. Liver Transpl. 2012;18(10):1209-16. PubMed PMID: 22740290.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value. AU - Tandon,Puneeta, AU - Ney,Michael, AU - Irwin,Ivana, AU - Ma,Mang M, AU - Gramlich,Leah, AU - Bain,Vincent G, AU - Esfandiari,Nina, AU - Baracos,Vickie, AU - Montano-Loza,Aldo J, AU - Myers,Robert P, PY - 2012/6/29/entrez PY - 2012/6/29/pubmed PY - 2013/3/13/medline SP - 1209 EP - 16 JF - Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society JO - Liver Transpl. VL - 18 IS - 10 N2 - As detected by cross-sectional imaging, severe muscle depletion, which is termed sarcopenia, holds promise for prognostication in patients with cirrhosis. Our aims were to describe the prevalence and predictors of sarcopenia in patients with cirrhosis listed for liver transplantation (LT) and to determine its independent prognostic significance for the prediction of waiting-list mortality. Adults listed for LT who underwent abdominal computed tomography/magnetic resonance imaging within 6 weeks of activation were retrospectively identified. The exclusions were hepatocellular carcinoma, acute liver failure, prior LT, and listing for multivisceral transplantation or living related LT. Sixty percent of the 142 eligible patients were male, the median age was 53 years, and the median Model for End-Stage Liver Disease (MELD) score at listing was 15. Forty-one percent were sarcopenic; sarcopenia was more prevalent in males versus females (54% versus 21%, P < 0.001) and increased with the Child-Pugh class (10% for class A, 34% for class B, and 54% for class C, P = 0.007). Male sex, the dry-weight body mass index (BMI), and Child-Pugh class C cirrhosis (but not the MELD score) were independent predictors of sarcopenia. Sarcopenia was an independent predictor of mortality (hazard ratio = 2.36, 95% confidence interval = 1.23-4.53) after adjustments for age and MELD scores. In conclusion, sarcopenia is associated with increased waiting-list mortality and is poorly predicted by subjective nutritional assessment tools such as BMI and subjective global assessment. If this is validated in larger studies, the objective assessment of sarcopenia holds promise for prognostication in this patient population. SN - 1527-6473 UR - https://www.unboundmedicine.com/medline/citation/22740290/Severe_muscle_depletion_in_patients_on_the_liver_transplant_wait_list:_its_prevalence_and_independent_prognostic_value_ L2 - https://doi.org/10.1002/lt.23495 DB - PRIME DP - Unbound Medicine ER -