A Pilot Study of Racial Differences in the Current Definition of Sarcopenia among Liver Transplant Candidates

Sarcopenia has been shown to have prognostic value in patients awaiting liver transplant. However, the presence of sarcopenia as a prognostic factor among patients awaiting liver transplantation might vary by race. This study aims to assess racial differences of sarcopenia in liver transplant candidates. This retrospective study assessed 102 patients on a liver transplantation list from 2012 to 2016 and used demographic and clinical variables to predict sarcopenia as measured by skeletal muscle index (SMI) and death or removal from the transplant list. Three racial groups were compared in the study: whites (n=34), Asians (n=50), and Native Hawaiians and Other Pacific Islanders (NHOPIs; n=18). NHOPI were more likely to have a body mass index (BMI) ≥ 30 and hepatitis B, and less likely to have alcoholic cirrhosis and sarcopenia than whites. Asians were more likely to have hepatitis B and less likely to have alcoholic cirrhosis and encephalopathy than other races. Using logistic regression, a BMI ≥ 30, multiple waiting list events, alcoholic cirrhosis, and sarcopenia were predictive of death or removal from the list. Although NHOPI had a higher BMI, they had less sarcopenia and similar frequency of ascites, encephalopathy, multiple waiting list events, and death or removal from the list compared to other races. Racial variations in muscle mass might have resulted in fewer NHOPI having sarcopenia as defined by the US criteria. Larger studies of patients with varying ethnicity are needed to develop a universally applicable definition of sarcopenia before we use this for liver transplant listing or allocation.