Association between Abdominal CT Measurements of Body Composition before Deceased Donor Liver Transplant with Posttransplant Outcomes

Omid Shafaat, Yi Liu, Kyle R. Jackson, Jennifer D. Motter, Brian J. Boyarsky, Muhammad A. Latif, Frank Yuan, Adham Khalil, Elizabeth A. King, Atif Zaheer, Ronald M. Summers, Dorry L. Segev, Mara McAdams-DeMarco, Clifford R. Weiss

Research output: Contribution to journalArticlepeer-review


Background: Pre–liver transplant (LT) sarcopenia is associated with poor survival. Methods exist for measuring body composition with use of CT scans; however, it is unclear which components best predict post-LT outcomes. Purpose: To quantify the association between abdominal CT–based body composition measurements and post-LT mortality in a large North American cohort. Materials and Methods: This was a retrospective cohort of adult first-time deceased-donor LT recipients from 2009 to 2018 who underwent pre-LT abdominal CT scans, including at the L3 vertebral level, at Johns Hopkins Hospital. Measurements included sarcopenia (skeletal muscle index [SMI] <50 in men and <39 in women), sarcopenic obesity, myosteatosis (skeletal muscle CT attenuation <41 mean HU for body mass index [BMI] <25 and <33 mean HU for BMI ≥25), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and VAT/SAT ratio. Covariates in the adjusted models were selected with use of least absolute shrinkage and selection operator regression with lambda chosen by means of 10-fold cross-validation. Cox proportional hazards models were used to quantify associations with post-LT mortality. Model discrimination was quantified using the Harrell C-statistic. Results: A total of 454 recipients (median age, 57 years [IQR, 50–62 years]; 294 men) were evaluated. In the adjusted model, pre-LT sarcopenia was associated with a higher hazard ratio (HR) of post-LT mortality (HR, 1.6 [95% CI: 1.1, 2.4]; C-statistic, 0.64; P = .02). SMI was significantly negatively associated with survival after adjustment for covariates. There was no evidence that myosteatosis was associated with mortality (HR, 1.3 [95% CI: 0.86, 2.1]; C-statistic, 0.64; P = .21). There was no evidence that BMI (HR, 1.2 [95% CI: 0.95, 1.4]), VAT (HR, 1.0 [95% CI: 0.98, 1.1]), SAT (HR, 1.0 [95% CI: 0.97, 1.0]), and VAT/SAT rati (HR, 1.1 [95% CI: 0.90, 1.4]) were associated with mortality (P = .15–.77). Conclusions: Sarcopenia, as assessed on routine pre–liver transplant (LT) abdominal CT scans, was the only factor significantly associated with post-LT mortality.

Original languageEnglish (US)
Article numbere212403
Issue number3
StatePublished - Mar 2023

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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