The role of sarcopenia on waitlist and post-transplant outcomes in liver transplantation for hepatocellular carcinoma
Recommended Citation
Rajendran L, Murillo Perez CF, Magyar C, Brar A, Claasen MP, Yoon P, Li Z, Ivanics T, Miranda E, Haider M, Sapisochin G. The role of sarcopenia on waitlist and post-transplant outcomes in liver transplantation for hepatocellular carcinoma. HPB (Oxford) 2024; 26:S531.
Document Type
Conference Proceeding
Publication Date
5-16-2024
Publication Title
HPB (Oxford)
Abstract
Introduction: Sarcopenia is common in patients with hepatocellular carcinoma (HCC); however, research on its role in waitlist and post-transplant outcomes for this population is limited. Our study aimed to assess this relationship at a large North American transplant institution. Methods: Adults with HCC listed for liver transplantation at Toronto General Hospital were retrospectively analyzed. Third lumbar vertebrae (L3) skeletal muscle index (SMI) and psoas muscle index (PMI) were calculated from the most recent scan prior to de-listing. Sarcopenia was defined by literature-established cut-offs for L3SMI and L3PMI. Primary outcomes included: overall survival (intention-to-treat), waitlist mortality, and post-transplant survival. Secondary outcomes included: 90-day complications and HCC recurrence. Results: Of 439 patients, 248(57%) were classified in the sarcopenia group by L3SMI cut-off, and 120(28%) by L3PMI cut-off. Intention-to-treat analysis demonstrated no survival difference between patients with or without sarcopenia from time of listing (L3SMI p=0.23, L3PMI p=0.99) or post-transplant (L3SMI p=0.43, L3PMI p=0.92). On competing risk analysis, sarcopenia was not associated with waitlist mortality (L3SMI p=0.30, L3PMI p=0.64). There were no differences in post-transplant overall 90-day complications or recurrence-free survival between groups. However, in patients stratified beyond Milan criteria pre-transplant, sarcopenia was associated with worse post-transplant survival (p=0.008) (FIGURE 1) and increased risk of death (HR 3.00 [95% CI 1.41-6.38], p=0.004). Conclusion: There was no association between sarcopenia and survival from time of listing or post-transplant in HCC patients, except in the beyond Milan criteria population. Sarcopenia is one factor that may help refine transplant criteria, especially for populations beyond Milan criteria. [Formula presented]
Volume
26
First Page
S531
