Impact of Body Composition on the Risk of Hepatocellular Carcinoma Recurrence After Liver Transplantation

Abstract

Background: Body composition parameters are reported to influence the risk of hepatocellular carcinoma (HCC) recurrence after liver resection, yet data on patients undergoing liver transplantation are scarce. The aim of this study was to evaluate the impact of the amount of abdominal adipose tissue and skeletal muscles on the risk of HCC recurrence after liver transplantation.

Methods: This was a retrospective observational study performed on 77 HCC patients after liver transplantation. Subcutaneous fat area (SFA), visceral fat area, psoas muscle area and total skeletal muscle area were assessed on computed tomography on the level of L3 vertebra and divided by square meters of patient height. The primary outcome measure was five-year recurrence-free survival.

Results: Recurrence-free survival in the entire cohort was 95.7%, 90.8%, and 86.5% after one, three, and five years post-transplantation, respectively. SFA was significantly associated with the risk of HCC recurrence (p = 0.013), whereas no significant effects were found for visceral fat and skeletal muscle indices. The optimal cut-off for SFA for prediction of recurrence was 71.5 cm²/m². Patients with SFA < 71.5 cm²/m² and ≥71.5 cm²/m² exhibited five-year recurrence-free survival of 96.0% and 55.4%, respectively (p = 0.001).

Conclusions: Excessive amount of subcutaneous adipose tissue is a risk factor for HCC recurrence after liver transplantation and may be considered in patient selection process.

Keywords: adipose tissue; computed tomography; hepatocellular carcinoma; liver transplantation; obesity; sarcopenia; subcutaneous fat; visceral fat.

Figure 1

Study flowchart.

Figure 2

Examples of muscle and adipose tissue measurements: (a) Subcutaneous Fat Area (b) Visceral Fat Area (c) Psoas Major Area (d) Total Skeletal Muscle Area. (a) red zone represents Subcutaneous Fat Area, in this patient it was 332.6 cm²/m² (b) red zone represents Visceral Fat Area, in this patient it was (138.9 cm²/m²) (c) red zone represents Psoas Major Area, in this patient it was 16.8 cm²/m² (d) red zone represents Total Skeletal Muscle Area, in this patient it was 123.2 cm²/m².

Figure 3

Recurrence-free survival after liver transplantation in HCC patients with (a) subcutaneous fat area <71.5cm²/m² and ≥71.5cm²/m² and (b) total fat area <90.5 cm²/m² and ≥90.5 cm²/m^2. . (a) Patients with the amount of subcutaneous fat area above the cut-off value had lower recurrence-free survival rates (b) Patients with the amount of total fat area above the cut-off value had lower recurrence-free survival rates.