Body composition predicts prognosis of patients with hepatocellular carcinoma after liver transplantation: A...

Sarcopenia is associated with poor prognosis in liver transplantation, but the prognostic value of broader body composition indicators in patients undergoing liver transplantation for hepatocellular carcinoma requires further investigation. This study aimed to explore their critical role in the precision evaluation system.

Consecutive cases from four centers between January 2015 and January 2022 were included. Pre-transplant abdominal computed tomography images were analyzed to assess body composition indicators, including skeletal muscle index (SMI), skeletal muscle radiation attenuation (SMRA), visceral adipose tissue index (VATI), and subcutaneous adipose tissue index (SATI). Survival analysis and Cox regression were performed to investigate the predictive efficacy of body compositions in recurrence-free survival (RFS), with interaction terms for Milan criteria status. A scoring model was developed using Framingham Heart Study methodology.

A total of 700 male recipients were enrolled. Among all body composition indicators, low SMI (called sarcopenia) and low SMRA (called myosteatosis) were associated with worse 2-year RFS regardless of Milan criteria status, whereas low VATI (P = 0.002) and low SATI (P = 0.001) were associated with worse RFS only in recipients exceeding the Milan criteria. These body composition indicators exhibited cumulative adverse effects on outcomes. Further analysis revealed significant interactions between Milan criteria status and sarcopenia, as well as low SATI. A body composition-based scoring model was developed, defining three risk classes with a C-index of 0.70 [95 % confidence interval (CI): 0.67-0.72], which significantly improved the predictive efficacy for recurrence compared to conventional criteria. Notably, using marginal liver was a risk factor for RFS in moderate risk patients (62.8 % vs. 48.8 %, P = 0.024).

This model highlights the prognostic value of body composition in liver transplantation for hepatocellular carcinoma and provides a refined predictive model to enhance recurrence risk assessment. The findings offer valuable insights for defining marginal liver utilization and developing effective treatment strategies.