Imaging-based assessment of sarcopenia in liver transplant candidates: A systematic review

Table 3 Association between sarcopenia and post-transplant survival in end-stage liver disease: Summary of sarcopenia prevalence, statistical associations, and survival outcomes reported in studies assessing post-liver transplantation prognosis in end-stage liver disease patients

Ref.	Prevalence of sarcopenia	Association with post-LT survival	Effect measure	Result
Molwitz et al[23], 2023	Pre-LT: 61%. Post-LT prevalence not reported in %	Significant (only myosteatosis, not muscle mass)	HR = 0.945 (95%CI: 0.903-0.990), P = 0.016	Myosteatosis predicted worse survival: 3 months (72% vs 95%), 1 year (63% vs 90%), 5 years (54% vs 84%), P = 0.001. SMI decreased post-LT but was not associated with survival
Golse et al[27], 2017	22%	Significant	Survival probabilities (Kaplan-Meier)	Sarcopenia, defined by psoas muscle area (cutoffs: < 1561 mm2 for male, < 1464 mm2 for female), was associated with lower post-LT survival, 1-year survival 59% vs 94%, and 5-year survival 54% vs 80% (log-rank P < 0.001)
Lee et al[31], 2021	1 year pre-LT: 77.8%. Pre-LT: 98.6%. Post-LT: 100%	Significant	HR	A large preoperative decrease in SMI (ΔSMI ≤ -30%) was significantly associated with reduced post-LT survival, HR = 0.284 (95%CI: 0.102-0.789), P = 0.016
Kyselova et al[32], 2025	44.7% in LT candidates; 47.6% in transplanted patients	Sarcopenia not significant; abnormal 31P MRS and myosteatosis linked to worse survival	HR	Abnormal 31P MRS (HR = 3.40; 95%CI: 1.50-7.71, P = 0.003) and myosteatosis (HR = 2.78; 95%CI: 1.14-6.78, P = 0.025) predicted poor long-term survival and perioperative complications better than sarcopenia
Chae et al[33], 2018	25% with high muscle loss (≤ 11.7%)	Significant	HR	High psoas muscle loss was independently associated with worse overall survival after liver transplantation: HR 1.87 (95%CI 1.07-3.25), P = 0.03
Kuo et al[38], 2019	Male 46%	Significant	HR	Male with sarcopenia had significantly higher post-LT mortality at 1 and 3 years. Sarcopenia was independently associated with increased risk of mortality after adjustment for MELD and liver disease etiology (univariable HR = 3.65, 95%CI 1.29-10.28, P = 0.01; multivariable HR = 4.39, P = 0.007)

LT: Liver transplantation; HR: Hazard ratio; CI: Confidence interval; SMI: Skeletal muscle index; ΔSMI: Change in skeletal muscle index; ³¹P MRS: Phosporus-31 magnetic resonance spectroscopy; MELD: Model for end-stage liver disease.