Abdominal adiposity, body composition and survival after liver transplantation

Clin Transplant. 2016 Mar;30(3):289-94. doi: 10.1111/ctr.12688. Epub 2016 Feb 13.


Background: Current measures of obesity do not accurately describe body composition. Using cross-sectional imaging, objective measures of musculature and adiposity are possible and may inform efforts to optimize liver transplantation outcomes.

Methods: Abdominal visceral fat area and psoas muscle cross-sectional area were measured on CT scans for 348 liver transplant recipients. After controlling for donor and recipient characteristics, survival analysis was performed using Cox regression.

Results: Visceral fat area was significantly associated with post-transplant mortality (p < 0.001; HR = 1.06 per 10 cm(2) , 95% CI: 1.04-1.09), as were positive hepatitis C status (p = 0.004; HR = 1.78, 95% CI: 1.21-2.61) and total psoas area (TPA) (p < 0.001; HR = 0.91 per cm(2) , 95% CI: 0.88-0.94). Among patients with smaller TPA, the patients with high visceral fat area had 71.8% one-yr survival compared to 81.8% for those with low visceral fat area (p = 0.15). At five yr, the smaller muscle patients with high visceral fat area had 36.9% survival compared to 58.2% for those with low visceral fat area (p = 0.023).

Conclusions: Abdominal adiposity is associated with survival after liver transplantation, especially in patients with small trunk muscle size. When coupled with trunk musculature, abdominal adiposity offers direct characterization of body composition that can aid preoperative risk evaluation and inform transplant decision-making.

Keywords: analytic morphomics; body composition; risk assessment; survival.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adiposity*
  • Body Composition*
  • Body Mass Index
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Image Processing, Computer-Assisted / methods
  • Intra-Abdominal Fat / diagnostic imaging
  • Intra-Abdominal Fat / pathology*
  • Liver Diseases / diagnostic imaging
  • Liver Diseases / mortality*
  • Liver Diseases / surgery
  • Liver Transplantation / mortality*
  • Male
  • Middle Aged
  • Obesity / diagnostic imaging
  • Obesity / mortality*
  • Prognosis
  • Psoas Muscles / diagnostic imaging
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Tomography, X-Ray Computed / methods