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Page 4 of 12 D’Arcangelo et al. Hepatoma Res 2021;7:4 I http://dx.doi.org/10.20517/2394-5079.2020.109

patients with and without HCC awaiting LT at a first-level center; and (2) to assess the impact of sarcopenia
on patient survival after LT in these patients.

Secondary objective of this study was to assess the impact of sarcopenia on post-LT length of
hospitalization and risk of short- and medium-term complications.

[6]
Because severity of cirrhosis may influence prevalence and impact of sarcopenia , we performed a post-hoc
analysis in compensated (Child A) and decompensated (Child B/C) patients separately (with vs. without
sarcopenia).

Because the muscle mass may vary over a 6 months period in patients with cirrhosis, we performed a post-hoc
analysis in patients who had CT scan within 3 months prior to LT and in patients who had CT scan
between 3 months and 6 months prior to LT, separately.

In the subgroup of patients with HCC, we hypothesized that pre-LT tumour burden might influence the
impact of sarcopenia on post-LT outcome. Hence, we analysed survival in patients with HCC beyond
[26]
Milan criteria and in patients with HCC within Milan criteria separately (with vs. without sarcopenia) .
Statistical analysis
Values for continuous variables are presented as mean ± standard deviation. Categorical-nominal variables
are presented as frequencies. For subgroup comparisons, quantitative variables were compared using
Student’s t-test or Mann-Whitney U test, and categorical variables using χ or Fisher’s exact tests, as
2
appropriate. Survival curves were estimated with Kaplan-Meier method and compared with log rank test.
All tests were 2-tailed, and P-value < 0.05 was considered statistically significant. Statistical analysis was
performed using SPSS (version 25.0).

RESULTS
Demographics and prevalence of sarcopenia
Of 475 patients who were screened for eligibility, 197 were included (male/female 153/44; mean age 57 years).
Reason for exclusion were as follows: no CT scan in the 6 months prior to LT (n = 235), more than one LT
(n = 40), and combined liver-kidney transplantation (n = 3).

Overall, the most common aetiology of cirrhosis was hepatitis C virus (HCV) infection (42%), followed
by alcoholic (19%), and combined HCV + alcoholic (12%) liver disease. In approximately 70% of these
patients, HCC was the indication for LT. In patients with HCC, MELD score was comparable between
those with HCC within compared to those with HCC beyond MC (12 vs. 11, respectively). On the other
hand, patients with HCC beyond MC tended to be more compensated compared with patients with HCC
within MC (Child A: 58% vs. 39% and Child B/C 42% vs. 61% in patients with HCC beyond vs. within MC,
respectively; P = 0.05).

Prevalence of sarcopenia was 62%, being relatively higher in male compared to female patients (65% vs.
50%, respectively). Overall, prevalence of sarcopenia increased in parallel with severity of liver dysfunction
(55% in Child A, 63% in Child B, and 72% in Child C patients). However, in sex-stratified analysis, this
association was significant in male (55% in Child A, 65% in Child B, and 80% in Child C patients; P = 0.03)
but not in female (56% in Child A, 56% in Child B, and 39% in Child C patients; P = 0.5) candidates. No
association was found between prevalence of sarcopenia and aetiology of cirrhosis (60% vs. 63% vs. 65% in
alcoholic, HCV, and metabolic patients, respectively), nor between sarcopenia and presence of HCC (55%
vs. 65% in patients with and without HCC, respectively). In the subgroup of patients with HCC, there was
a trend towards a higher prevalence of sarcopenia in those with HCC beyond Milan criteria compared to