ARRS 2022 Abstracts

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1889. Computed Tomography Image Measures of Body Composition in Liver Transplant Recipients
Authors * Denotes Presenting Author
  1. Omid Shafaat *; Johns Hopkins University School of Medicine
  2. Yi Liu; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins University School of Medicine
  3. Muhammad Latif; Johns Hopkins University School of Medicine
  4. Frank Yuan; Johns Hopkins University School of Medicine
  5. Ronald Summers; National Institute of Health
  6. Mara McAdams-Demarco; Johns Hopkins Bloomberg School of Public Health; Johns Hopkins University School of Medicine
  7. Clifford Weiss; Johns Hopkins University School of Medicine
Objective:
Body composition varies across liver transplant (LT) recipients, and certain phenotypes are associated with worse post-LT outcomes. Although many different body composition measures can be acquired from pre-transplant CT scans, it is unclear which predicts best post-LT outcomes and therefore could be used to augment pre-LT risk prediction. To better inform this process, we compared the relative performance of several different CT-based body composition measures (sarcopenia, sarcopenic obesity, myosteatosis, visceral adipose tissue [VAT], subcutaneous adipose tissue (SAT), and VAT/SAT ratio) in predicting post-LT outcomes.

Materials and Methods:
We identified 454 deceased donor LT recipients from 2009-2019 at our center who had available pre-LT abdominal CT scans covering the L3 vertebral level. We used OsiriX to draw a closed polygon with the region of interest (ROI) tool. We measured skeletal muscle index (SMI) to define sarcopenia (SMI <50 cm2/m2 in men and<39 cm2/m2 in women) and sarcopenic obesity (concurrent sarcopenia and BMI=30). We also measured skeletal muscle radiation attenuation (SM-RA) to define myosteatosis (SM-RA<41 mean HU in BMI of up to 24.9 kg/m2 and <33 mean HU for BMI =25 kg/m2) and measured VAT, SAT, and VAT/SAT ratio. We used adjusted Cox regression models to quantify the association between these measurements and post-LT mortality and graft failure.

Results:
One hundred thirty-six (29.9%) recipients were found to be sarcopenic, and 276 (60.8%) recipients were found to have myosteatosis. LT recipients with sarcopenia had a higher adjusted risk of mortality (aHR= 1.71, 95% CI: 1.14, 2.55) and a higher adjusted risk of graft failure (aHR=1.50, 95% CI: 1.01, 2.23). Myosteatosis was not associated with mortality (aHR= 1.45, 95% CI: 0.93, 2.27) or graft failure (aHR= 1.28, 95% CI: 0.84, 1.96). Additionally, a decrease in SM-RA was associated with a higher risk of mortality (aHR=1.19 for every 5 units, 95% CI: 1.05, 1.36), and graft failure (aHR=1.15 for every 5 units, 95% CI: 1.01, 1.31). BMI, VAT, SAT, and the VAT/SAT ratio were not associated with mortality or all-cause graft failure (p>0.05).

Conclusion:
CT-based pre-LT body composition measures can be obtained from available pre-LT CT scans and can be used as a new prognostic tool to predict outcomes of LT. Of these measures, sarcopenia was most highly associated with poorer post-LT outcomes.