Body Mass Index is commonly used, but is likely to be an inexact measurement of nutritional status. For this reason, we examined whether body composition measurements from direct visualization on computerized tomography scans provide new insights both into the degree of malnutrition and distribution of fat in different compartments in patients undergoing to multivisceral (MVTx) or liver–intestinal transplantation (LITx). Methods: Body composition was assessed in 44 adult patients undergoing MVTx ⁄ LITx by using a L3–4 transverse abdominal CT section and specific software designed to measure fat and muscle compartments. Results: Median patient age was 44 (range 20–66). Twenty three patients were female (52%). Twenty nine patients received multivisceral allografts (66%). The average (SD) MELD score was 23 (1.8). Albumin and total protein levels were 3.2±0.7 g/dL and 6.8±0.9 g/dL, respectively. Using established cutoffs for significant muscle loss at the L3–4 transverse section (i.e. ≤52.4 cm²/m² for men and ≤38.5 cm²/m² for women), cachexia was found in 90%, despite normal BMI (i.e. 18.5 to 29.9) in 65% of the patients. BMI was 24.5±7.5 and 20.3±5.8 for males and females, respectively. Muscle mass normalized for patients' height was 39.2 for male and 27.3 cm²/m² for female. The proportion of visceral fat was higher in males (139.5 vs 71.8 cm²) with no significant differences regarding the subcutaneous fat (149.3 vs 145.7 cm²). Cachexia is a common finding and BMI does not appear to reflect the nutritional status of MVTx ⁄ LITx transplant candidates. Body composition by CT scan data provides a specific method to identify muscle wasting and fat distribution on this specific population. Whether these data can help in the prognostication of outcomes and survival requires further investigation.

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