Body Composition in Liver Transplant Patients: Long-Term Changes and Impact on Recovery Outcomes

Area of Science:

• Hepatology
• Transplantation Medicine
• Body Composition Analysis

Background:

• Sarcopenia and obesity are common in end-stage liver disease (ESLD) patients awaiting liver transplantation (LT).
• These conditions often persist post-LT, complicating recovery.
• Body mass index (BMI) is an unreliable measure of adiposity in ESLD; visceral-to-subcutaneous adipose tissue (VAT/SAT) ratio is a better indicator of outcomes.

Purpose of the Study:

• To investigate long-term changes in body composition after LT.
• To examine the association between pre- and post-LT body composition and patient survival.
• To determine the relationship between body composition and hospital/ICU stay duration.

Main Methods:

• Retrospective cohort study of 81 adult LT recipients (2009-2015).
• Body composition (skeletal muscle index, VAT, SAT) assessed via CT/MRI at L3 level pre-LT and up to 10 years post-LT.
• Statistical analyses included linear mixed models, survival analysis, and Spearman correlations.

Main Results:

• Pre-LT, 61% of patients were sarcopenic, and 19% had sarcopenic obesity.
• Post-LT, skeletal muscle index declined but showed partial recovery; BMI initially decreased then increased.
• Elevated pre-LT visceral adipose tissue (VAT) and VAT/SAT ratio were linked to prolonged ICU and hospital stays.

Conclusions:

• Sarcopenia persists long-term post-LT and is associated with reduced survival.
• Unfavorable fat distribution, particularly visceral adiposity, correlates with increased hospital resource utilization.
• Early identification and management of sarcopenia and visceral adiposity are recommended to enhance post-LT outcomes.