The Role of Sarcopenia and Body Composition in Lung Transplant Candidates: A Review

CT-derived body composition metrics such as skeletal muscle index (SMI), pectoralis muscle index (PMI), muscle radiation attenuation (MRA), and visceral fat area (VFA) have emerged as promising prognostic tools in lung transplant candidates. This systematic review evaluates their utility in pre- and post-transplant risk assessment and rehabilitation through a detailed literature search of PubMed, Google Scholar, and Excerpta Medica Database (EMBASE), identifying 21 relevant studies. Reduced muscular area (SMI) and quality (MRA) were associated with increased mortality, prolonged mechanical ventilation, and extended ICU stay, while low MRA correlated with higher rates of infection and graft dysfunction. Elevated VFA was linked to increased metabolic complications, and composite phenotypes such as sarcopenic obesity conferred additional risk. These findings suggest that CT-derived body composition metrics provide valuable, objective insights for transplant risk stratification and recovery. Standardized imaging protocols and integration with functional assessments are needed to support their widespread clinical adoption and optimize outcomes for high-risk lung transplant candidates.