4789. Automated Abdominal CT Imaging Biomarkers Associated with Deceased-Donor Liver Transplant Outcomes
Authors * Denotes Presenting Author
  1. David Ji; University of Wisconsin
  2. Daniel Liu *; University of Wisconsin
  3. John Garrett; University of Wisconsin
  4. Ryan Zea; University of Wisconsin
  5. Adam Kuchnia; University of Wisconsin
  6. Ronald Summers; NIH Clinical Center
  7. Perry Pickhardt; University of Wisconsin
Pretransplant CT body composition measures can provide prognostic value in deceased-donor liver transplant outcomes. Previous research has shown conflicting results for sarcopenia and myosteatosis as relevant pretransplant risk factors. Our purpose was to quantify the potential of fully automated CT-based body composition metrics in predicting liver transplant recipient postoperative outcomes.

Materials and Methods:
Fully automated artificial intelligence-based body composition tools were applied to pretransplant abdominal CT scans in a retrospective cohort of deceased-donor liver transplant recipients. Outputs for body composition included measurements for liver (volume and attenuation), spleen (volume and attenuation), L3-level skeletal muscle (area and attenuation), L1-level trabecular bone mineral density (BMD), abdominal aortic calcium (Agatston score), and L3-level areas and attenuation for visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Age- and sex-corrected hazard ratios (HRs) were analyzed according to highest-risk quartiles compared with the other quartiles combined. Area under the receiver operating characteristic curve (ROC AUC) analysis in univariate and multivariate scenarios were also performed.

There were 598 first-time recipients (median age, 56 years [IQR, 49 - 61]; 383 men, 215 women) were included in this study with transplant dates from 2005 - 2021. Mean clinical follow-up interval after transplant was 8.6 ± 4.47 years with 224 deaths (mean interval, 5.3 ± 3.9 years posttransplant), and 246 graft failures (mean interval, 4.7 ± 4.0 years posttransplant) observed. HRs included 1.53 (95% CI, 1.14 - 2.06) for L3-level muscle attenuation (<em>p</em> < .01), 1.66 (95% Cl, 1.24 - 2.22) for aortic Agatston score (<em>p</em> < .001), 1.35 (1.02 - 1.80) for L3 SAT area (<em>p</em> < .05), and 1.82 (1.35 - 2.46) for liver volume (<em>p</em> < 0.001). Multivariate 10-year AUC for predicting mortality was 0.675 using liver volume, aortic Agatston score, and muscle attenuation.

Automated CT measurements of muscle density, abdominal aortic calcification, abdominal fat, and liver volume are predictive of mortality in first-time liver transplant recipients.