Sarcopenia and Fat Mass in Children With Chronic Liver Disease and Its Impact on Liver Transplantation

In adults, weight loss and sarcopenia are prognostic indicators of poor outcomes for patients awaiting liver transplant (LT). We tested the hypothesis that sarcopenia in children awaiting LT was related to poor outcomes. METHODS: Children with end-stage chronic liver disease undergoing assessment for LT were recruited into an observational longitudinal study. Anthropometry and body composition (BC; whole-body dual-energy x-ray absorptiometry scan) were assessed before and, on average, 1 year after LT. RESULTS: Eleven children (6 females:5 males) were assessed (4.7 to 17.2 years; median, 9.9) at baseline. Nine children went on to have an LT. The aspartate aminotransferase-to-platelet ratio index had a significant positive correlation with trunk lean mass and trunk lean mass index (LMI) SD score (SDS). At baseline, 4 patients were sarcopenic with appendicular LMI SDS less than −1.96. All fat mass and fat mass index (FMI) SDSs were within the normal range (above −1.96). There was a strong negative correlation between FMI SDS and height SDS. After transplant, there was a significant reduction in trunk LMI from 1.20 to −0.51 (95% CI, 1.03-2.4; P < 0.01). Body mass index SDS had a negative correlation with days to discharge after transplant. The majority of patients discharged after 16 days were sarcopenic. One year after transplantation, all patients were alive with normal graft function regardless of BC before LT. CONCLUSION: FMIs were normal regardless of LMIs and correlated negatively with height. BC was related to days to discharge after LT but not to outcomes a year after LT.