Introduction
Sarcopenia, a progressive loss of skeletal muscle mass and function, is a significant predictor of adverse outcomes in liver transplant patients, including infections. This study evaluates the relationship between pre-transplant sarcopenia and infection rates at one, three-, and six-months post-transplantation, using radiological markers such as skeletal muscle mass index (SMII), intramuscular adipose tissue content (IMAC), and visceral/subcutaneous fat area ratio (VSR).
Aims & Methods
This retrospective study analysed 102 liver transplant recipients undergone surgery between July 2012 and July 2023. Computed tomography (CT) scans taken within 30 days prior to transplantation were evaluated to assess sarcopenia using SMII, IMAC, and VSR. Demographics, clinical parameters, and infection rates at one, three, and six months were compared. Pre-transplant sarcopenia indicators were assessed for their correlation with early and late infection rates. Using a forward conditional method for variable selection, logistic regression was applied to identify significant predictors of infection up to the third month post-transplant. Statistical analyses included chi-square and Mann-Whitney U tests.
Results
The median age of the cohort was 51 years, and 31.4% were female. Patients were categorized into sarcopenic (n=41) and non-sarcopenic (n=61) groups based on preoperative imaging data. Sarcopenia was significantly less prevalent in females (17.1% vs. 41%; p=0.016). Sarcopenic patients had a lower median SMII (61.54 vs. 100; p<0.001) and higher preoperative MELD-Na scores (24 vs. 18; p=0.02). One-month infection rates were significantly higher in sarcopenic patients (48.8% vs. 27.8%; p=0.032), as were three-month rates (65.8% vs. 44.2%; p=0.043). By six months, infection rates were similar between groups (60.7% vs. 57.3%; p=0.41). Logistic regression identified sarcopenia (OR = 10.92, 95% CI [1.53, 78.09], p = .017), urea (OR = 1.10, 95% CI [1.03, 1.17], p = .003), INR (OR = 6.03, 95% CI [1.05, 34.52], p = .044), and age (OR = 0.91, 95% CI [0.84, 0.99], p = .035) as significant predictors of infection up to the third month. While diabetes mellitus (DM) was not statistically significant (p > .05), its inclusion enhanced the model's predictive power. These findings indicate that higher sarcopenia, urea, and INR values increase infection risk, while older age appears protective.
Conclusion
Pre-transplant sarcopenia is strongly associated with increased infection rates in the first three months following liver transplantation. However, by six months, the comparable infection rates suggest that sarcopenia-related risks may diminish with recovery. These findings underscore the importance of addressing sarcopenia preoperatively through tailored interventions.
