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Updated: Jul 30, 2025
Author Spotlight: Evaluating Therapeutic Strategies to Enhance Liver Regeneration
Published on: May 24, 2024
Sarcopenia and Fat Mass in Children With Chronic Liver Disease and Its Impact on Liver Transplantation
Eirini Kyrana1, Jane E Williams2, Jonathan C Wells2
1From the King's College Hospital NHS Foundation Trust and MowatLabs, London, United Kingdom.
Insights
Sarcopenia, or low muscle mass, in children awaiting liver transplants (LT) did not predict outcomes one year post-transplant. However, body composition did influence hospital discharge times after LT.
Area of Science:
- Pediatric Hepatology
- Transplant Surgery
- Nutritional Science
Background:
- Sarcopenia and weight loss are poor prognostic indicators in adult liver transplant (LT) candidates.
- The prognostic value of sarcopenia in pediatric LT candidates remains unclear.
Purpose of the Study:
- To investigate the relationship between sarcopenia and outcomes in children awaiting LT.
- To assess the impact of body composition on post-LT recovery.
Main Methods:
- An observational longitudinal study included children with end-stage chronic liver disease assessed for LT.
- Body composition (BC) was measured using dual-energy x-ray absorptiometry before and one year after LT.
- Anthropometric data and clinical outcomes were recorded.
Main Results:
- Four of eleven pediatric LT candidates were sarcopenic at baseline (appendicular lean mass index SD score < -1.96).
- Fat mass index correlated negatively with height, but was otherwise normal.
- Post-LT, trunk lean mass index significantly decreased, and low body mass index correlated with longer hospital discharge times.
- All patients survived one year post-LT with normal graft function, irrespective of baseline body composition.
Conclusions:
- Sarcopenia in children awaiting LT was not associated with poor outcomes one year after transplant.
- Body composition influenced post-transplant hospital discharge duration but not long-term graft function or survival.
Abstract:
In adults, weight loss and sarcopenia are prognostic indicators of poor outcomes for patients awaiting liver transplant (LT). We tested the hypothesis that sarcopenia in children awaiting LT was related to poor outcomes.
Methods:
Children with end-stage chronic liver disease undergoing assessment for LT were recruited into an observational longitudinal study. Anthropometry and body composition (BC; whole-body dual-energy x-ray absorptiometry scan) were assessed before and, on average, 1 year after LT.
Results:
Eleven children (6 females:5 males) were assessed (4.7 to 17.2 years; median, 9.9) at baseline. Nine children went on to have an LT. The aspartate aminotransferase-to-platelet ratio index had a significant positive correlation with trunk lean mass and trunk lean mass index (LMI) SD score (SDS). At baseline, 4 patients were sarcopenic with appendicular LMI SDS less than -1.96. All fat mass and fat mass index (FMI) SDSs were within the normal range (above -1.96). There was a strong negative correlation between FMI SDS and height SDS. After transplant, there was a significant reduction in trunk LMI from 1.20 to -0.51 (95% CI, 1.03-2.4; P < 0.01). Body mass index SDS had a negative correlation with days to discharge after transplant. The majority of patients discharged after 16 days were sarcopenic. One year after transplantation, all patients were alive with normal graft function regardless of BC before LT.
Conclusion:
FMIs were normal regardless of LMIs and correlated negatively with height. BC was related to days to discharge after LT but not to outcomes a year after LT.
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