Sarcopenia as a Predictor of Mortality Among Cirrhotic Patients Awaiting Liver Transplantation

Background and Aims: Sarcopenia is common among cirrhotic patients awaiting liver transplantation, but its prognostic significance in the Asian population remains unclear. This retrospective study aimed to evaluate the association between sarcopenia and mortality risk in Thai cirrhotic patients awaiting transplantation. Patients and Methods: We analyzed data from 162 cirrhotic patients (112 men; mean age 55.0 ± 8.2 years) listed for liver transplantation with available computed tomography for skeletal muscle index (SMI) measurement at the third lumbar vertebra. Sarcopenia was defined using sex-specific thresholds by the Japan Society of Hepatology. Waitlist mortality was analyzed using the Fine–Gray competing risk model, with liver transplantation treated as a competing event. Results: The mean SMI was 45.6 ± 9.1 cm²/m², with 27.8% of patients having sarcopenia. Cirrhosis etiology was not associated with sarcopenia. During a median waitlist time of 13.5 months, 87 patients (53.7%) died while waiting, and 45 (27.8%) were transplanted. Sarcopenic patients had a shorter median transplant-free survival (8.4 vs. 16.7 months, p = 0.029) and were more prone to bacterial infections (51.1% vs. 34.2%, p = 0.049) and sepsis-related death (33.3% vs. 17.9%, p = 0.036). Sarcopenia significantly increased the risk of death on the waiting list (subdistribution hazard ratio [sHR] 1.72; 95% CI 1.12-2.66), particularly in patients with Child–Turcotte–Pugh class A/B cirrhosis (sHR 2.38; 95% CI 1.38–4.11). In multivariate analysis, sarcopenia remained an independent predictor of mortality (adjusted sHR 1.69; 95% CI 1.04–2.76) after adjusting for sex and Model for End-Stage Liver Disease–sodium score. Conclusion: Sarcopenia is a significant predictor of mortality in cirrhotic patients awaiting liver transplantation.