Systematic Review and Meta-Analysis of the Impact of Computed Tomography Assessed Skeletal Muscle Mass on Outcome in Patients Awaiting or Undergoing Liver Transplantation.
1Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
2Biostatistics, Erasmus University Medical Center, Rotterdam, Netherlands
3Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, Netherlands.
Meeting: 2016 American Transplant Congress
Abstract number: B276
Keywords: Allocation, Liver, Meta-analysis, Survival
Session Information
Session Name: Poster Session B: Liver: MELD, Allocation and Donor Issues (DCD/ECD)
Session Type: Poster Session
Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Background
Although liver transplant outcome has improved significantly, the shortage of human organs remains prevalent. Therefore, strict patient selection is of paramount importance. Recently, low CT-assessed skeletal muscle mass was identified as a novel prognostic parameter to predict outcome in liver transplant candidates. Our aim was to perform a systematic review and meta-analysis on the association between CT-assessed muscle mass and outcome in liver transplant candidates.
Methods
A systematic search was performed according to the PRISMA-guidelines. Eligibility and quality assessment, and data-extraction were performed in duplicate. Meta-analyses were performed using random effects models.
Results
Nineteen studies, including 3803 partly overlapping patients (65% male, mean age 52-62), fulfilled the inclusion criteria. Main indications for transplantation were viral infections, followed by alcoholic liver cirrhosis. Median MELD-score ranged from 9-21, albumin level 2.8-3.4 g/dl, and BMI 24.0-29.4 kg/m[sup2]. Sarcopenia prevalence ranged from 20-70% and various (gender-specific) cut-off values were used. The pooled hazard ratio of sarcopenia for waiting list mortality was 1.75 (95% CI 1.02-3.01, p=0.04). However, this finding is of limited value due to a small number of studies. The pooled hazard ratios of sarcopenia and cross-sectional skeletal muscle mass (per incremental cm2/m2) for post-transplant mortality were 1.84 (95% CI 1.11-3.05, p=0.02, figure 1) and 0.98 (95% CI 0.96-1.00, p=0.05), respectively, independent of MELD score.
Conclusions
Sarcopenia impairs outcome in patients undergoing liver transplantation. Limited evidence also suggests that sarcopenia is associated with waiting list mortality. Therefore, skeletal muscle mass assessment may contribute to pre-transplant risk assessment.
CITATION INFORMATION: van Vugt J, Levolger S, de Bruin R, van Rosmalen J, Metselaar H, IJzermans J. Systematic Review and Meta-Analysis of the Impact of Computed Tomography Assessed Skeletal Muscle Mass on Outcome in Patients Awaiting or Undergoing Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Vugt Jvan, Levolger S, Bruin Rde, Rosmalen Jvan, Metselaar H, IJzermans J. Systematic Review and Meta-Analysis of the Impact of Computed Tomography Assessed Skeletal Muscle Mass on Outcome in Patients Awaiting or Undergoing Liver Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/systematic-review-and-meta-analysis-of-the-impact-of-computed-tomography-assessed-skeletal-muscle-mass-on-outcome-in-patients-awaiting-or-undergoing-liver-transplantation/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress