Sarcopenia Predicts Tumor Recurrence Post Liver Transplantation?

John Schieszer

Recurrence risk was greater in sarcopenic patients, and greater alpha-fetoprotein and microvascular invasion were independent risk factors.

Sarcopenia may be an important prognostic factor for post-transplant tumor recurrence of advanced hepatocellular carcinoma (HCC). Researchers in Korea, in a studypublished in Scientific Reports, note that sarcopenia appears to be one of the important host factors modulating tumor recurrence risk after living donor liver transplantation (LDLT) for advanced HCC.

Young Ri Kim, from Sungkyunkwan University School of Medicine, Seoul, Korea, et al evaluated the association between sarcopenia and tumor recurrence after LDLT in 92 males who underwent LDLT for treating HCC beyond the Milan criteria. These criteria are used for patients with cirrhosis and HCC when under consideration for liver transplantation with intent to cure the disease. For this investigation, the researchers defined sarcopenia as height-normalized psoas muscle thickness < 15.5 mm/m at the L3 vertebra level on CT, based on an optimum stratification method using the Gray’s test statistic.

The researchers performed a survival analysis with death as a competing risk event and post-transplant HCC recurrence as the primary outcome. The researchers found there was a 9% increase in recurrence risk per unit decrease in height-normalized psoas muscle thickness, after a median follow-up of 36 months (range: 17–80 months). In this cohort, 26 of 72 sarcopenic recipients (36.1%) developed HCC recurrence. However, only one of 20 nonsarcopenic recipients (5.0%) developed HCC recurrence.

In univariable analysis, the recurrence risk was greater in sarcopenic patients (hazard ratio [HR], 8.06) and the findings were similar in multivariable analysis (HR, 9.49). The researchers also identified greater alpha-fetoprotein and microvascular invasion as independent risk factors.

Among the 92 patients, 78 had hepatitis B as the primary etiology of HCC, 8 had hepatitis C as the primary etiology, alcohol was listed for 3 patients, and 3 were listed as unknown. All but one patient (91 out of 92) presented with chronic liver cirrhosis, and 1 presented with acute-on-chronic liver failure. Among the 23 recipients who died, 16 died of HCC recurrence and 7 died from HCC-unrelated causes. The investigators found there was a trend toward higher HCC-related death risk in sarcopenic patients (HR, 3.89). However, the risk of HCC-unrelated death was comparable regardless of sarcopenia (HR, 1.53).

The researchers found that several factors in addition to sarcopenia were significantly associated with HCC recurrence. They included graft-to-recipient weight ratio, recipient gender, body mass index, alpha-fetoprotein level, tumor size, and microvascular invasion. The mechanism underlying the association between sarcopenia and HCC recurrence is unclear. However, it may be explained in part by tumor microenvironment and cytokines, according to the authors.