Pre-transplant physical performance, muscle quality, and body composition as predictors of post-liver transplant outcomes: a retrospective cohort study

BACKGROUND AND AIM: Sarcopenia, marked by muscle loss and weakness, is common in cirrhotic patients undergoing liver transplantation and is associated with poor postoperative outcomes. This study aimed to evaluate the impact of pre-transplant sarcopenia, assessed through handgrip strength (HGS), skeletal muscle indices (SMIs), bioelectrical impedance analysis (BIA), and the 6-min walk test (6MWT), on post-transplant mortality and hospital length of stay (LOS). METHODS: This retrospective cohort study was conducted on 127 cirrhotic patients who underwent liver transplantation between 2022 and 2023. Pre-transplant assessments included 6MWT, BIA, HGS, and SMI, and their associations with post-transplant outcomes, including LOS and mortality, were analyzed using Cox and linear regression models. RESULTS: In the fully adjusted model, a 6-min walk distance (6MWD) greater than 450 m was associated with a 76% reduction in the risk of mortality (HR = 0.24, p-trend = 0.049). Higher lean body mass to fat mass (LBM/FM) and stronger HGS were linked to reduced mortality (HR = 0.33, 95% CI 0.1-0.99 and HR = 0.17, 95% CI 0.04-0.73, respectively). SMI at T12 and L3 levels was associated with shorter LOS (p = 0.047 and p = 0.035, respectively). CONCLUSION: Pre-transplant muscle function and quality were linked to post-transplant outcomes. Higher LBM/FM and stronger HGS were associated with lower mortality, while higher T12 and L3 SMIs correlated with shorter hospital stays, emphasizing the importance of muscle assessments in pre-transplant evaluations. Our data indicate that sarcopenia is a strong predictor of liver transplant prognosis; management of sarcopenia before liver transplantation may reduce mortality.