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Background <p>Sarcopenia after liver transplantation is poorly characterized in recipients with metabolic dysfunction-associated steatotic liver disease (MASLD) and severe obesity. We evaluated longitudinal changes in psoas muscle index (PMI) after transplantation and examined whether PMI trajectory was associated with post-transplant survival.</p> Methods <p>We performed a retrospective single-center study of adults with MASLD and body mass index ≥ 35&#xa0;kg/m<sup>2</sup> who underwent orthotopic liver transplantation between January 2015 and June 2023. PMI was measured on computed tomography at the L3 level before transplantation and at 6&#xa0;months, 1&#xa0;year, 3&#xa0;years, and 5&#xa0;years when available. Longitudinal change was assessed using linear mixed-effects models adjusted for survival status. Survival analyses included Kaplan–Meier estimation and univariate logistic regression.</p> Results <p>Seventy-three recipients were included; mean age was 59.3&#xa0;years, 50.7% were women, median body mass index was 38.1&#xa0;kg/m2, and mean Model for End-Stage Liver Disease score was 23.6. PMI declined significantly from baseline to 6&#xa0;months (β =  − 0.60, 95% confidence interval [CI] − 0.98 to − 0.22; <i>p</i> = 0.002) and 1&#xa0;year (β =  − 0.46, 95% CI − 0.83 to − 0.09; <i>p</i> = 0.015), with persistent reduction at 3&#xa0;years. Survivors showed modest early decline followed by relative stabilization, whereas non-survivors demonstrated steeper decline. However, pre-transplant PMI, 6-month PMI, and early PMI change were not significantly associated with mortality.</p> Conclusions <p>In liver transplant recipients with MASLD and severe obesity, muscle loss worsens during the first post-transplant year and may persist thereafter. These findings raise questions regarding optimal timing of nutritional and physical rehabilitation and justify larger studies to determine the prognostic significance of post-transplant muscle trajectories.</p>

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Psoas Muscle Trajectory and Survival After Liver Transplantation for Steatotic Liver Disease in Severe Obesity

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月22日

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  • Baila Elkin,
  • Mohammad Alabbas,
  • Qijun Yang,
  • Blake Brandon,
  • Christopher Coppa,
  • Manal Abdelmalek,
  • Omar T. Sims,
  • Jamile Wakim-Fleming

摘要

Background

Sarcopenia after liver transplantation is poorly characterized in recipients with metabolic dysfunction-associated steatotic liver disease (MASLD) and severe obesity. We evaluated longitudinal changes in psoas muscle index (PMI) after transplantation and examined whether PMI trajectory was associated with post-transplant survival.

Methods

We performed a retrospective single-center study of adults with MASLD and body mass index ≥ 35 kg/m2 who underwent orthotopic liver transplantation between January 2015 and June 2023. PMI was measured on computed tomography at the L3 level before transplantation and at 6 months, 1 year, 3 years, and 5 years when available. Longitudinal change was assessed using linear mixed-effects models adjusted for survival status. Survival analyses included Kaplan–Meier estimation and univariate logistic regression.

Results

Seventy-three recipients were included; mean age was 59.3 years, 50.7% were women, median body mass index was 38.1 kg/m2, and mean Model for End-Stage Liver Disease score was 23.6. PMI declined significantly from baseline to 6 months (β =  − 0.60, 95% confidence interval [CI] − 0.98 to − 0.22; p = 0.002) and 1 year (β =  − 0.46, 95% CI − 0.83 to − 0.09; p = 0.015), with persistent reduction at 3 years. Survivors showed modest early decline followed by relative stabilization, whereas non-survivors demonstrated steeper decline. However, pre-transplant PMI, 6-month PMI, and early PMI change were not significantly associated with mortality.

Conclusions

In liver transplant recipients with MASLD and severe obesity, muscle loss worsens during the first post-transplant year and may persist thereafter. These findings raise questions regarding optimal timing of nutritional and physical rehabilitation and justify larger studies to determine the prognostic significance of post-transplant muscle trajectories.