LAUSR

BACKGROUND We examined the association between sarcopenia and posttransplant mortality in acutely ill inpatients with cirrhosis who underwent urgent liver transplantation. METHODS Included were inpatients at 4 centers who were urgently listed as non-Status 1 and transplanted from 2005-17 with an abdominal computed tomography scan <90 days prior. Skeletal muscle index (SMI) = total skeletal muscle cross sectional area the L3 vertebral level, normalized to height. Cox regression associated SMI with posttransplant mortality. Optimal search identified SMI cutoffs to detect survival. RESULTS Of 126 inpatients: 63% were male, MELD-Na was 32, and follow up was 5.1 years. Among men: 23% died. Median SMI was lower in men who died versus survived (45 versus 51 cm/m). SMI was associated with posttransplant mortality (HR=0.96 per cm/m, 95%CI 0.92-0.99). Patients with SMI ≤ versus >48 cm/m experienced higher rates of death at 1- (86% versus 95%) and 3-years (73% versus 95%) (logrank P = 0.01). In MELD-adjusted analysis, sarcopenia was strongly associated with posttransplant mortality (HR=4.39, 95%CI 1.49-12.97).Among women: 35% died. Median SMI was similar in women who died versus survived (45 versus 44 cm/m). SMI was not associated with posttransplant mortality (HR=1.02, 95%CI 0.96-1.09). Optimal search did not identify any SMI cutoff that predicted posttransplant mortality. CONCLUSION Among patients who underwent urgent inpatient evaluation and liver transplantation, we identified an SMI cut-off of 48 cm/m to predict posttransplant mortality in men. Our data support the use of SMI as a tool to capture the impact of muscle depletion on posttransplant mortality in acutely ill men with cirrhosis undergoing urgent liver transplantation.