Sarcopenia (loss of muscle mass) is common in patients with end stage liver disease (ESLD). Sarcopenia is potentially reversible after liver transplantation (LT) but no studies have evaluated the changes in muscle mass following LT.

Aim: To determine whether sarcopenia of cirrhosis reverses after LT.

Methods

Data were collected from a prospective transplant database at our institution. 206 patients with ESLD with pre-operative cross sectional imaging (computed tomography (CT) or magnetic resonance imaging (MRI) within 90 days prior to LT were included. Variables collected included: age, race, gender, etiology of liver disease and Model for End-Stage Liver Disease (MELD) score. Sarcopenia was assessed by measuring the cross-sectional area of left and right psoas muscle. The individual imaging (either CT or MRI) at the superior aspect of fourth lumbar vertebrae was identified. The right and left psoas areas were outlined and the resulting enclosed area was computed. The mean cross sectional area of both right and left psoas area (total psoas area, TPA) was used for data analysis. Follow-up cross sectional imaging studies, either CT or MRI within 6 months after LT (n=39), between 6 months-1 year (n=40) and at 2 years following LT (n=12) were also identified and mean TPA was analyzed.

Results

In 206 cirrhotic patients, the mean age was 54.5±9 and 63.1% were males. Etiology of ESLD was as follows: chronic viral hepatitis (44.7%), alcohol (16.1%), cholestatic liver disease (9.2%), cryptogenic + NASH (19.4%) and others (10.6%). Mean MELD score was 14.6±6.8. The pre-transplant mean TPA was 1272.4±2650.3 mm². Follow-up cross sectional imaging analysis was performed and the mean TPA was determined to be 1218.7±314.5 mm² (0-6 months after LT), 1199.9±318.7 mm² (6 months -1 year after LT) and 1200.8±212 mm² (2 years after LT). The changes in TPA between pre-LT and post-LT follow-up imaging were not significantly different.

Conclusions

No change was found in the TPA before and after LT. The reason for the lack of improvement in muscle area after LT is unclear. Perhaps, like bone mineral density, muscle mass may improve after LT but never reaches the pre-LT level. It is possible that additional improvement would be noted with longer follow-up or with a larger sample size. Larger longitudinal studies are necessary to further understand the natural history of cirrhotic sarcopenia before and after LT.

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