Subcutaneous Fat Density Is an Independent Predictor of Adverse Outcomes and Shows Early Improvement After Liver Transplantation

Background and Aims Body composition is increasingly recognised as a prognostic determinant in cirrhosis, particularly in liver transplant (LT) candidates. We aimed to assess adipose and muscle compartments on computed tomography (CT) before and after LT and to evaluate their associations with mortality. Methods We recruited prospectively 121 patients with cirrhosis listed for LT. CT scans at the third lumbar vertebral level were analysed to quantify cross‐sectional area (cm 2 ) and density (Hounsfield units, HU) of skeletal muscle, subcutaneous adipose tissue (SAT), and visceral adipose tissue. A subset underwent a CT‐scan 6 months post‐LT. Results Most patients were male (76%), and the median MELD score was 14 (IQR 10–20). High SAT density (> −83 HU in women; > −74 HU in men) was associated with higher pre‐transplant mortality ( p = 0.005) and with reduced overall survival during follow‐up ( p = 0.005) compared to lower SAT density. The combined phenotype of low muscle density and high SAT density identified the subgroup with the poorest survival ( p = 0.002). From baseline to 6 months post‐LT, SAT density decreased significantly ( p = 0.0134), whereas muscle parameters did not change significantly. Conclusions This prospective observational cohort study demonstrates that SAT density is a prognostic CT‐derived marker in patients with cirrhosis awaiting LT with significant post‐transplant dynamics. The impact of altered adipose tissue therefore warrants attention in this situation.