• Andrea DiMartini, Ruy J Cruz, Mary Amanda Dew, Larissa Myaskovsky, Bret Goodpaster, Kristen Fox, Kevin H Kim, and Paulo Fontes.
• Departments of Transplantation Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA; Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
• Liver Transpl. 2013 Nov 1;19(11):1172-80.

AbstractFor patients with end-stage liver disease, commonly used indices of nutritional status (ie, body weight and body mass index) are often inflated because of fluid overload (ie, ascites and peripheral edema), and this results in an underdiagnosis of malnutrition. Because muscle is the largest protein reservoir in the body, an estimate of the muscle mass may be a more reliable and valid estimate of nutritional status. Therefore, we used pretransplant computed tomography data for 338 liver transplantation (LT) candidates to identify muscle and fat mass on the basis of a specific abdominal transverse section commonly used in body composition analyses, and we investigated the contribution of this measure to specific post-LT outcomes. We found that the majority of our patients (68%) could be defined as cachectic. For men, muscle mass predicted many important posttransplant outcomes, including intensive care unit (ICU) stay, total length of stay (LOS), and days of intubation. Muscle mass was a significant predictor of survival and also predicted disposition to home versus another facility. For women, muscle mass predicted ICU stay, total LOS, and days of intubation, but the effect was modest. Muscle mass did not predict survival or disposition for women. In conclusion, because pretransplant muscle mass is associated with many important postoperative outcomes, we discuss these findings in the context of possible pretransplant interventions for either improving or sustaining muscle mass before surgery.© 2013 American Association for the Study of Liver Diseases.

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