Quirino Lai1, Paolo Magistri2, Raffaella Lionetti3, Alfonso W Avolio4, Ilaria Lenci5, Valerio Giannelli6, Annarita Pecchi7, Flaminia Ferri8, Giuseppe Marrone9, Mario Angelico5, Martina Milana5, Vincenzo Schinniná10, Renata Menozzi11, Michele Di Martino12, Antonio Grieco9, Tommaso M Manzia13, Giuseppe Tisone13, Salvatore Agnes4, Massimo Rossi1, Fabrizio Di Benedetto2, Giuseppe M Ettorre14. 1. General Surgery and Organ Transplantation Unit, Sapienza University, Rome, Italy. 2. Hepato-biliopancreatic and Transplant Surgery Unit, University of Modena, Modena, Italy. 3. Infectious Diseases - Hepatology Unit, Istituto Nazionale Malattie Infettive Lazzaro Spallanzani-IRCCS, Rome, Italy. 4. General Surgery and Liver Transplant Unit, Università Cattolica - Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy. 5. Hepatology Unit, Tor Vergata University, Rome, Italy. 6. Hepatology Unit, San Camillo Hospital, Rome, Italy. 7. Radiology Unit, University of Modena, Modena, Italy. 8. Gastroenterology Unit, Sapienza University, Rome, Italy. 9. Internal Medicine and Transplant Hepatology Unit, Università Cattolica - Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy. 10. Diagnostic imaging Unit, Istituto Nazionale Malattie Infettive Lazzaro Spallanzani-IRCCS, Rome, Italy. 11. Metabolic Disease and Clinical Nutrition Unit, University of Modena, Modena, Italy. 12. Diagnostic Imaging and Radiology Unit, Sapienza University, Rome, Italy. 13. Hepatobiliary and Transplant Surgery Unit, Tor Vergata University, Rome, Italy. 14. General Surgery and Transplant Unit, San Camillo Hospital, Rome, Italy.
Abstract
BACKGROUND & AIMS: Sarcopenia in liver transplantation (LT) cirrhotic candidates has been connected with higher dropouts and graft losses after transplant. The study aims to create an 'urgency' model combining sarcopenia and Model for End-stage Liver Disease Sodium (MELDNa) to predict the risk of dropout and identify an appropriate threshold of post-LT futility. METHODS: A total of 1087 adult cirrhotic patients were listed for a first LT during January 2012 to December 2018. The study population was split into a training (n = 855) and a validation set (n = 232). RESULTS: Using a competing-risk analysis of cause-specific hazards, we created the Sarco-Model2 . According to the model, one extra point of MELDNa was added for each 0.5 cm2 /m2 reduction of total psoas area (TPA) < 6.0 cm2 /m2 . At external validation, the Sarco-Model2 showed the best diagnostic ability for predicting the risk of 3-month dropout in patients with MELDNa < 20 (area under the curve [AUC] = 0.93; P = .003). Using the net reclassification improvement, 14.3% of dropped-out patients were correctly reclassified using the Sarco-Model2 . As for the futility threshold, transplanted patients with TPA < 6.0 cm2 /m2 and MELDNa 35-40 (n = 16/833, 1.9%) had the worse results (6-month graft loss = 25.5%). CONCLUSIONS: In sarcopenic patients with MELDNa < 20, the 'urgency' Sarco-Model2 should be used to prioritize the list, while MELDNa value should be preferred in patients with MELDNa ≥ 20. The Sarco-Model2 played a role in more than 30% of the cases in the investigated allocation scenario. In sarcopenic patients with a MELDNa value of 35-40, 'futile' transplantation should be considered.
BACKGROUND & AIMS:Sarcopenia in liver transplantation (LT) cirrhotic candidates has been connected with higher dropouts and graft losses after transplant. The study aims to create an 'urgency' model combining sarcopenia and Model for End-stage Liver Disease Sodium (MELDNa) to predict the risk of dropout and identify an appropriate threshold of post-LT futility. METHODS: A total of 1087 adult cirrhotic patients were listed for a first LT during January 2012 to December 2018. The study population was split into a training (n = 855) and a validation set (n = 232). RESULTS: Using a competing-risk analysis of cause-specific hazards, we created the Sarco-Model2 . According to the model, one extra point of MELDNa was added for each 0.5 cm2 /m2 reduction of total psoas area (TPA) < 6.0 cm2 /m2 . At external validation, the Sarco-Model2 showed the best diagnostic ability for predicting the risk of 3-month dropout in patients with MELDNa < 20 (area under the curve [AUC] = 0.93; P = .003). Using the net reclassification improvement, 14.3% of dropped-out patients were correctly reclassified using the Sarco-Model2 . As for the futility threshold, transplanted patients with TPA < 6.0 cm2 /m2 and MELDNa 35-40 (n = 16/833, 1.9%) had the worse results (6-month graft loss = 25.5%). CONCLUSIONS: In sarcopenic patients with MELDNa < 20, the 'urgency' Sarco-Model2 should be used to prioritize the list, while MELDNa value should be preferred in patients with MELDNa ≥ 20. The Sarco-Model2 played a role in more than 30% of the cases in the investigated allocation scenario. In sarcopenic patients with a MELDNa value of 35-40, 'futile' transplantation should be considered.
Authors: Franziska Alexandra Meister; Georg Lurje; Suekran Verhoeven; Georg Wiltberger; Lara Heij; Wen-Jia Liu; Decan Jiang; Philipp Bruners; Sven Arke Lang; Tom Florian Ulmer; Ulf Peter Neumann; Jan Bednarsch; Zoltan Czigany Journal: Cancers (Basel) Date: 2022-01-30 Impact factor: 6.639