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

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Figure 4. Post-transplant survival in the subgroup of patients with hepatocellular carcinoma (HCC). Overall survival was comparable in
patients with (green line) vs. without (blue line) sarcopenia (A); when the analysis was adjusted according to Milan Criteria, sarcopenia
was associated with reduced survival in patients with HCC beyond Milan criteria but not in those with HCC within Milan criteria (B)

The analysis was then adjusted per the timing of CT scan prior to LT; and patients with CT scan within
3 months prior to LT (n = 125) and those with CT scan between 3 months and 6 months prior to LT (n =
72) were analysed separately. Interestingly, we found that sarcopenia in was associated with lower survival
in decompensated but not in compensated patients in both groups; however in patients with CT scan
between 3 months and 6 months, the difference was not as significant (P = 0.05) as in those with CT within
3 months prior to LT (P < 0.001).

In the subgroup of patients with HCC (n = 142), no difference in survival was found between patients
with (n = 83) and without (n = 59) sarcopenia. When the analysis was adjusted for tumour status at the
time of transplantation, sarcopenia was associated with a trend towards reduced survival in patients with
HCC beyond Milan criteria (28 patients with sarcopenia vs. 14 patients without sarcopenia) but not in
patients with HCC within Milan criteria (48 patients with sarcopenia vs. 44 patients without sarcopenia)
in whom survival was comparable between the two subgroups [Figure 4]. In patients with HCC beyond
Milan criteria, rate of HCC recurrence was slightly higher in patients with HCC beyond Milan criteria with
sarcopenia compared to patients without sarcopenia (33% vs. 22%, respectively); however, the difference
was not statistically significant (P = 0.4).

Table 2 shows secondary outcomes in patients with vs. without sarcopenia. Length of hospitalization,
rates of PNF, acute and chronic cellular rejection, biliary complications, and de novo malignancy were not
different between patients with and without sarcopenia [Table 2]. On the other hand, bacterial infections
were more frequent in patients with compared to those without sarcopenia (50% vs. 35%; P = 0.02) [Table 2].