# Opportunistic computed tomography-based sarcopenia screening and mortality after liver transplantation: a systematic review and meta-analysis

## TL;DR

This study shows that using CT scans to detect muscle loss in liver disease patients can predict higher mortality risk after liver transplants.

## Contribution

The study introduces the Psoas Muscle Index as a reliable CT-based method for sarcopenia screening in liver disease patients, linking it to post-transplant mortality.

## Key findings

- Sarcopenic patients diagnosed via CT had a 4.1 times higher mortality risk after liver transplantation.
- The Psoas Muscle Index method showed consistent results with minimal heterogeneity across studies.
- Opportunistic CT-based sarcopenia screening can help identify high-risk patients pre-transplant.

## Abstract

The aim of this study was to investigate the diagnosis of sarcopenia in chronic liver disease by opportunistic computed tomography screening using the Psoas Muscle Index method as a predictor of mortality after liver transplantation.

We systematically searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials from July 2014 to July 2024. We restricted inclusion in this meta-analysis to observational studies and clinical trials on adult patients with chronic liver disease diagnosed with sarcopenia by computed tomography undergoing liver transplantation or on a waiting list. We included the one with a larger sample size for studies with overlapping populations. We excluded studies with therapeutic interventions, animal experiments, cell-line studies, editorial pieces, commentaries, review articles, and case reports.

After the removal of duplicate records and ineligible studies, 163 remained and were thoroughly reviewed based on inclusion criteria. Of these, a total of 11 studies were included in qualitative synthesis and four studies were included in quantitative analysis (meta-analysis), comprising 382 patients. Patients with muscle mass loss after liver transplantation diagnosed by computed tomography scan using the Psoas Muscle Index method had a 4.1 times higher risk of death than non-sarcopenic patients (random-effects model: OR 4.1386; 95%CI 2.4215–7.0730; p<0.0001). Interpretatively, a scale with an I2 value close to 0% indicates no heterogeneity. The other criteria also did not reject the hypothesis of homogeneity among the articles.

Patients with muscle mass loss diagnosed by computed tomography using the Psoas Muscle Index method had a fourfold increased mortality risk after transplantation. The findings reinforce the need to identify sarcopenic patients preoperatively to optimize liver transplantation outcomes. Using the Psoas Muscle Index, an opportunistic diagnosis by computed tomography scan can be helpful in this setting.