Patients with end stage liver disease (ESLD) suffer from malnutrition and skeletal muscle wasting. In patients awaiting liver transplantation (LT), sarcopenia (loss of muscle mass and strength) has been associated with increased pre- and post-LT mortality. In geriatric patients, sarcopenia is related to reduced quality of life. However, the factors affecting skeletal muscle mass in ESLD are unknown.

Aim: To identify and explore the relationships between sarcopenia, health related quality of life, Body mass index (BMI) and other biochemical parameters.

Methods

An internal prospective database of all patients listed for LT was queried. Data collected: patient demographics, etiology of liver disease, BMI, albumin, total bilirubin, INR, MELD score, bone mineral density (BMD), pre-transplant short form- 36 scores [mental component score (MCS) and physical component score (PCS)]. Cross sectional imaging (computed tomography or magnetic resonance imaging) prior to LT was reviewed and individual imaging segment at the superior aspect of fourth lumbar vertebrae was identified. The borders of left and right psoas muscle were outlined and the enclosed psoas muscle area was computed. Total mean psoas area (TPA) was measured and included for analysis. Correlation between TSA and other variables were determined by Pearson correlation coefficient (r) analysis.

Results

Two hundred and seventy seven patients with ESLD awaiting LT were enrolled in the study. Mean TPA and SF- 36 data was available for 266 and 217 patients respectively. The mean age was 55±9 and 62.5% were males. Chronic viral hepatitis (46.3%) was the most common etiology of liver disease. The mean native MELD score was 15.2 and BMI was 28.6 ± 5.7 kg/m². The mean PCS score was 33.8±11.5 and mean MCS score was 46.8±11.1. The TPA was 1206 mm2 and mean psoas density was 27.4 ±30.7 Hounsfield units. The TPA did not significantly correlate with age, MELD score, albumin, bilirubin, INR, vitamin D or BMI. There was no significant relationship between TSA, PCS (r=0.11, p=0.16) and MCS (r=0.01, p=0.8).

Conclusions

Sarcopenia as determined by TPA is not associated with age, MELD scores or nutritional parameters such as BMI or vitamin D. Sarcopenia also did not correlate with quality of life SF-36 scores. More studies are needed to evaluate the factors affecting the muscle mass since sarcopenia impacts the mortality in patients with ESLD.

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