# The Role of Sarcopenia and Body Composition in Lung Transplant Candidates: A Review

## TL;DR

This review explores how CT-based body composition metrics help assess risk and recovery in lung transplant candidates.

## Contribution

The paper systematically evaluates the clinical utility of CT-derived body composition metrics in lung transplant outcomes.

## Key findings

- Low muscle area and quality correlate with higher mortality and ICU stay in lung transplant candidates.
- Elevated visceral fat is linked to metabolic complications and sarcopenic obesity increases risk.
- Standardized imaging protocols are needed to support clinical adoption of these metrics.

## Abstract

CT-derived body composition metrics such as skeletal muscle index (SMI), pectoralis muscle index (PMI), muscle radiation attenuation (MRA), and visceral fat area (VFA) have emerged as promising prognostic tools in lung transplant candidates. This systematic review evaluates their utility in pre- and post-transplant risk assessment and rehabilitation through a detailed literature search of PubMed, Google Scholar, and Excerpta Medica Database (EMBASE), identifying 21 relevant studies. Reduced muscular area (SMI) and quality (MRA) were associated with increased mortality, prolonged mechanical ventilation, and extended ICU stay, while low MRA correlated with higher rates of infection and graft dysfunction. Elevated VFA was linked to increased metabolic complications, and composite phenotypes such as sarcopenic obesity conferred additional risk. These findings suggest that CT-derived body composition metrics provide valuable, objective insights for transplant risk stratification and recovery. Standardized imaging protocols and integration with functional assessments are needed to support their widespread clinical adoption and optimize outcomes for high-risk lung transplant candidates.