Muscle Mass Measurement Is Objective and More Predictive of Expected Mortality Than Functional Status in High MELD Liver Transplant Recipients

J. Nolte,¹ S. Gordon Burroughs,¹ D. Victor,¹ C. Mobley,¹ N. Yu,² T. Hirase,¹ A. Saharia,¹ A. Rajaraman,¹ L. Moore,¹ A. Gaber,¹ R. Ghobrial.¹

¹Surgery, Houston Methodist Hospital, Houston, TX
²Radiology, Houston Methodist Hospital, Houston, TX.

Meeting: 2015 American Transplant Congress

Abstract number: 109

Keywords: High-risk, Liver transplantation, Mortality

Session Information

Session Name: Concurrent Session: Liver Retransplantation and Other Complications

Session Type: Concurrent Session

Date: Sunday, May 3, 2015

Session Time: 4:00pm-5:30pm

Presentation Time: 5:00pm-5:12pm

Location: Room 115-AB

Introduction: Calculations used to determine expected survival post-liver transplant (OLT) are in part based on pre-OLT functional status. Functional status is subjectively measured by Karnofsky Index (KI) and correlates poorly with mortality in the highest acuity candidates. We sought to determine whether degree of sarcopenia as measured by average psoas area could better predict risk of post-OLT mortality within a subset of high model of end-stage liver disease (MELD) score candidates.

Methods: We retrospectively evaluated 57 patients with MELD scores ≥25–49 who were transplanted 2008-2013 with pre-transplant cross sectional imaging and KI ≤40%. Muscle mass was measured as average psoas area at L3. Patients were divided into tercile groups based on high (10.13 cm2 [Group A]), medium (6.29 cm2 [Group B]), and low (4.39 cm2 [Group C]) mean psoas areas. Post-operative outcomes including mortality, time to KI >70%, and post-OLT ICU length of stay (LOS) were compared.

Results: Despite equivalent MELD and KI's between all terciles (Table 1), Group C mortality was highest (35.3% vs 10.0% in A and B, p<0.05). There was no statistical significance between groups for Days to KI >70%, however, a trend exists for longer time in Group C compared to Groups A and B. ICU LOS was significantly less in Group C compared to Groups A and B (p<0.05).

Outcomes of psoas tercile Groups A, B and C
Tercile Group	Mean psoas area(cm2)	Mean MELD [SD]	Mortality (%)	ICU LOS (days [SD]	Time to >70% Karnofsky index (days [SD])	Mean Karnofsky Index at listing
A (n=20)	10.13	37 [6]	10	27.1	183.1 [185]	45
B (n=20)	6.29	38 [6]	10	26.6	148.1 [127.4]	45
C (n=17)	4.39	35 [6]	35.3	18.8	248 [303.6]	41

Conclusion: Though all groups had equivalent MELDs and poor pre-OLT KI, extreme sarcopenia was associated with highest mortality and longest time to functional recovery. Objective muscle mass measurement, a better reflection of the extreme depletion of muscle stores seen in high MELD patients, may be a better predictor of mortality and thus expected survival than KI.

To cite this abstract in AMA style:

Nolte J, Burroughs SGordon, Victor D, Mobley C, Yu N, Hirase T, Saharia A, Rajaraman A, Moore L, Gaber A, Ghobrial R. Muscle Mass Measurement Is Objective and More Predictive of Expected Mortality Than Functional Status in High MELD Liver Transplant Recipients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/muscle-mass-measurement-is-objective-and-more-predictive-of-expected-mortality-than-functional-status-in-high-meld-liver-transplant-recipients/. Accessed January 18, 2025.

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