Elizabeth J. Carey, Jennifer C. Lai, Connie W. Wang, Srinivasan Dasarathy, Iryna Lobach, Aldo J. Montano-Loza, Michael A. Dunn, for the Fitness, Life Enhancement, and Exercise in Liver Transplantation Consortium. “A multicenter study to define sarcopenia in patients with end-stage liver disease.” Liver Transplantation 2017 May;23(5):625-633.
ABSTRACT: Sarcopenia is associated with increased wait-list mortality, but a standard definition is lacking. In this retrospective study, we sought to determine the optimal definition of sarcopenia in end-stage liver disease (ESLD) patients awaiting liver transplantation (LT). Included were 396 patients newly listed for LT in 2012 at 5 North American transplant centers. All computed tomography scans were read by 2 individuals with interobserver correlation of 98%. Using image analysis software, the total cross-sectional area (cm2 ) of abdominal skeletal muscle at the third lumbar vertebra was measured. The skeletal muscle index (SMI), which normalizes muscle area to patient height, was then calculated. The primary outcome was wait-list mortality, defined as death on the waiting list or removal from the waiting list for reasons of clinical deterioration. Sex-specific potential cutoff values to define sarcopenia were determined with a grid search guided by log-rank test statistics. Optimal search methods identified potential cutoffs to detect survival differences between groups. The overall median SMI was 47.6€‰cm2 /m2 : 50.0 in men and 42.0 in women. At a median of 8.8 months follow-up, mortality was 25% in men and 36% in women. Patients who died had lower SMI than those who survived (45.6 versus 48.5€‰cm2 /m2 ; P€‰<€‰0.001), and SMI was associated with wait-list mortality (hazard ratio, 0.95; P€‰<€‰0.001). Optimal search method yielded SMI cutoffs of 50€‰cm2 /m2 for men and 39€‰cm2 /m2 for women; these cutoff values best combined statistical significance with a sufficient number of events to detect survival differences between groups. In conclusion, we recommend that an SMI€‰<€‰50€‰cm2 /m2 for men and€‰<€‰39€‰cm2 /m2 for women be used to define sarcopenia in patients with ESLD awaiting LT. Liver Transplantation 23 625-633 2017 AASLD.
For full text, please click here.
