Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation

Zoltan Czigany, Wiebke Kramp, Jan Bednarsch, Gregory van der Kroft, Joerg Boecker, Pavel Strnad, Markus Zimmermann, Ger Koek, Ulf Peter Neumann, Georg Lurje*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Muscle wasting and alterations of body composition are linked to clinical outcomes in numerous medical conditions. The role of myosteatosis in posttransplant outcomes remains to be determined. Here we investigated skeletal muscle mass and myosteatosis as prognostic factors in patients undergoing orthotopic liver transplantation (OLT). The data of 225 consecutive OLT recipients from a prospective database were retrospectively analyzed (May 2010-December 2017). Computed tomography-based skeletal-muscle-index (muscle mass), visceral-fat-area (visceral adiposity), and mean skeletal-muscle-radiation-attenuation (myosteatosis) were calculated using a segmentation tool. Cut-off values of myosteatosis resulted in a good stratification of patients into low- and high-risk groups in terms of morbidity (Clavien-Dindo >= 3b). Patients with myosteatosis had significantly higher complication rates (90-day Comprehensive Complication Index 68 +/- 32 vs 44 +/- 30, P <.001) and also displayed significantly longer intensive care (18 +/- 25 vs 11 +/- 21 days, P <.001) and hospital stay (56 +/- 55 vs 33 +/- 24 days, P <.001). Estimated costs were 44% higher compared to patients without myosteatosis. Multivariable analysis identified myosteatosis as an independent prognostic factor for major morbidity (odds ratio: 2.772, confidence interval: 1.516-5.066, P = .001). Adding myosteatosis to the well-established Balance-of-Risk-(BAR) score resulted in an increased prognostic value compared to the original BAR score. Myosteatosis may be a useful parameter to predict perioperative outcome in patients undergoing OLT, supporting the role of muscle quality (myosteatosis) over quantity (muscle mass) in this setting.

Original languageEnglish
Pages (from-to)493-503
Number of pages11
JournalAmerican Journal of Transplantation
Issue number2
Early online date18 Sept 2019
Publication statusPublished - Feb 2020


  • body composition
  • clinical decision-making
  • clinical research
  • practice
  • complication
  • liver transplantation
  • hepatology
  • myosteatosis
  • sarcopenia
  • RISK


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