Klinisch II - P16 - Systematic review and meta-analysis of the impact of com­puted tomography assessed skeletal muscle mass on outcome in patients awaiting or undergoing liver transplantation

J.L.A. van Vugt, S. Levolger, R.W.F. de Bruin, J. van Rosmalen, H.J. Metselaar, J.N.M Ijzermans

Chair(s): prof. dr. Herold Metselaar, MDL-arts, Erasmus MC Rotterdam

Thursday 10 march 2016

12:30 - 13:00h at Foyer

Categories: Postersessie

Parallel session: Postersessies XI - Opgesplitst in 3 tijdblokken en 3 categoriëen (klinisch, basaal, donatie)

Background and aims:
Although liver transplant outcome has improved significantly, the shortage of human organs remains prevalent. Therefore, strict patient selection is of paramount importance. Recently, low CT-assessed skeletal muscle mass was identified as a novel prognostic parameter to predict outcome in liver transplant candidates. Our aim was to perform a systematic review and meta-analysis on the association between CT-assessed muscle mass and outcome in liver transplant candidates.

Methods:
A systematic search was performed according to the PRISMA-guidelines. Eligibility and quality assessment, and data-extraction were performed in duplicate. Meta-analyses were performed using random effects models. Results: In total, 19 studies, including 3803 partly overlapping patients (65% male, mean age 52-62), fulfilled the inclusion criteria. Main indications for transplantation were viral infections, followed by alcoholic liver cirrhosis. Median MELD-score ranged from 9-21, albumin level 2.8-3.4 g/dl, and BMI 24.0-29.4 kg/m². Nine studies reported the cross-sectional muscle area (CSA, cm²) with corresponding skeletal muscle index (SMI; CSA corrected for height, cm²/m²), whereas the psoas area (PA) and dorsal muscle group area were reported in nine and one study, respectively. Sarcopenia prevalence ranged from 20-70% and various (gender-specific) cut-off values were used. The pooled hazard ratio of sarcopenia for waiting list mortality was 1.75 (95% CI 1.02-3.01, p=0.04). However, this finding is of limited value due to a small number of studies. The pooled hazard ratios of sarcopenia and cross-sectional skeletal muscle mass (per incremental cm²/m²) for post-transplant mortality were 1.84 (95% CI 1.11-3.05, p=0.02) and 0.98 (95% CI 0.96-1.00, p=0.05), respectively, independent of MELD score. Due to substantial heterogeneity between reported outcome measures, no meta-analyses could be performed for short-term outcomes.

Conclusion:
Sarcopenia impairs outcome in patients undergoing liver transplantation. Limited evidence also suggests that sarcopenia is associated with waiting list mortality. Therefore, skeletal muscle mass assessment may contribute to pre-transplant risk assessment.