S2527 Impact of Sarcopenia on Outcomes in Liver Transplant Recipients: A Nationwide Analysis

Introduction: Sarcopenia has been increasingly identified as a critical factor impacting outcomes in patients undergoing liver transplantation (LT). Emerging evidence underscores that sarcopenia in transplant recipients is also associated with an elevated risk of post-transplant complications, prolonged hospital stays and higher mortality rates. The current study aims to assess the impact and burden of sarcopenia on outcomes in LT recipients. Methods: The National Inpatient Sample (NIS) Database (2016-2022) was used to identify all adult LT recipients. Patients were categorized into 2 groups based on the presence or absence of sarcopenia. Data was collected on patient demographics, etiology of liver disease and decompensations of liver disease. The outcomes studied include in-hospital mortality, shock, acute kidney injury (AKI), intensive care unit (ICU) stay and LT-related complications. The impact of sarcopenia was assessed using the multivariate logistic/linear regression analysis. Results: Among 170,650 LT recipients, 24,525 (14.4%) developed sarcopenia. Most of the patients with sarcopenia were men (57.4%). A higher prevalence of hepatic encephalopathy (11.6% vs 5.5%), ascites (13.4% vs 5.8%), and hepatorenal syndrome (HRS) (2.3% vs 0.7%) was noted in patients with sarcopenia. Patients with sarcopenia also had a higher incidence of in-patient mortality (4.9% vs 1.9%), shock (9.1% vs 3.6%), AKI (47.2% vs 36.7%), ICU stay (10.1% vs 4.0%) and LT-related complications (3.7% vs 2.1%) as compared to those who did not have sarcopenia. After adjusting for confounding factors, sarcopenia was associated with a higher odds of in-patient mortality (aOR-2.16, 95% CI-1.83-2.56, P < 0.001), shock (aOR-2.18, 95% CI-1.92-2.48, P < 0.001), AKI (aOR-1.4, 95% CI-1.32-1.49, P < 0.001), ICU stay (aOR-2.23, 95% CI-1.98-2.52, P < 0.001), LT-related complications (aOR-1.47, 95% CI-1.23-1.75, P < 0.001), longer length of stay (adj. coefficient-4.71 days, 95% CI-4.31-5.10, P < 0.001) and total hospitalization charges (adj. coefficient-$56,359.88, 95% CI-$49,737.17-$62,982.58, P < 0.001). Conclusion: Our study noted that sarcopenia is linked with worse clinical outcomes and higher resource utilization in LT recipients. Early detection and management of sarcopenia are therefore essential for identifying patients at risk and implementing targeted interventions to enhance recovery and minimize complications.