Association between computed tomography-based adipose tissue parameters and liver transplant outcomes in patients...

The prognostic value of skeletal muscle in liver transplant recipients with hepatocellular carcinoma (HCC) has been documented; however, the role of adipose tissue remains ambiguous. This study aimed to evaluate the association between adipose tissue and transplant outcomes in patients with HCC.

A total of 765 patients with HCC who underwent liver transplantation (LT) at 3 transplant centers were included in this retrospective study. Computed tomography (CT) scans were utilized to quantify the area and radiodensity of visceral and subcutaneous adipose tissue. Cut-off values for adipose tissue parameters were determined based on tertiles. The Cox proportional hazards models were established to identify the predictors of overall survival (OS) and tumor recurrence.

Median age at transplant was 53 years, most were male (89.0 %) and cirrhotic (91.7 %). The median follow-up was 40.3 months. In univariate survival analysis, patients with high subcutaneous adipose tissue radiodensity (SATr) (>-86.5 HU) exhibited significantly lower 5-year OS rates than those with low SATr (49.9 % vs. 65.3 %, P < 0.001). Adjusted analyses revealed that high SATr independently predicted increased mortality (HR, 1.498; 95 % CI, 1.175-1.909; P = 0.001). SATr significantly increased during the first month postoperatively (P < 0.001), with one-third of the patients exhibiting an SATr change rate exceeding 10 %. An increase in SATr >10 % was independently associated with poorer OS (HR, 1.549; 95 % CI, 1.095-2.190; P = 0.013) and higher recurrence risk (HR, 1.776; 95 % CI, 1.242-2.540; P = 0.002).

Higher preoperative SATr was an independent predictor of patient mortality after LT for HCC. Postoperatively, a SATr increase >10 % during the first month was independently associated with elevated risk of mortality and tumor recurrence.