Prevalence and clinical impact of sarcopenia in liver transplant recipients: A meta-analysis

Table 1 Characteristics of the included studies

Ref.	Country	Methods for measuring muscle mass	Definition of sarcopenia	Sample size (n)	Mean age (yr)	Male (%)	HCC (%)	BMI (Kg/m2)	Follow-up time	NOS
Kumar et al[2], 2020	India	CT: L3-SMI	L3-SMI < 52.4 cm2/m2 for male and < 38.5 cm2/m2 for female	115	46.30 ± 10.20	90.4	-	24.5 ± 4.3	90 d	7
Bhanji et al[8], 2019	United States	CT: L3-SMI	L3-SMI < 50 cm2/m2 in men and < 39 cm2/m2 in women	293	51.95 ± 11.00	70.3	30.4	27.51 ± 5.73	13	8
Shafaat et al[26], 2023	United States	CT: L3-SMI	L3-SMI < 50 cm2/m2 in men, < 39 cm2/m2 in women	454	57.00 ± 8.89	65.0	-	29.0 ± 5.7	11yr	9
Sim et al[27], 2022	Korea	CT: L3-SMI	L3-SMI < 39.9cm2/m2 in men, < 28.9 cm2/m2 in women	2816	53.00 ± 7.41	75.0	52.8	24.2 ± 3.1	7.8 yr	8
Prakash et al[28], 2022	India	CT: L4-PMTH	L4-PMTH < 1 mm/m for men and < 10.4 mm/m for women	51	46.40 ± 9.10	96.1	37.3	23.34 ± 5.1	-	7
Wu et al[29], 2021	Taiwan China	CT: L3-PMI	L3-PMI < 2.63 cm2/m2 for female	122	52.32 ± 7.98	55.0	24.6	24.83 ± 4.45	10 yr	8
Kuo et al[30], 2019	United States	CT: L3-SMI	L3-SMI < 48 cm2/m2 for men	126	53.00 ± 8.89	63.0	14.0	28 ± 6.67	10.6 yr	8
Golse et al[31] 2017	France	CT: L3-4 PMA	L3-4 PMA < 1464 mm2 in women and < 1561 mm2 in men	256	5.003 ± 10.50	76.6	40.0	25.3 ± 10.5	8 yr	8
Beumer et al[32], 2022	Multicenter international study	CT: L3-SMI	L3-SMI < 37 cm2/m2 for women with a BMI < 25 kg/m2 or 42 cm2/m2 for women with a BMI ≥ 25 kg/m2, and < 45 cm2/m2 for men with a BMI < 25 kg/ m2, or < 51 cm2/m2 for men with a BMI ≥ 25 kg/m2	528	57.00 ± 9.00	86.0	100.0	26.67 ± 5.02	5 yr	8
Pinto Dos Santos et al[33], 2020	Germany	CT: L3-PSMI	L3-PSMI < 18.6 cm2/m2	368	56.80 ± 9.70	69.3	44.6	25.2 ± 4.37	10 yr	7
Izumi et al[34], 2017	Japan	CT: L3-PMI	L3-PMI < 612.5 mm2/m2 in men and < 442.9 mm2/m2 in women	47	54.00 ± 10.00	51.1	23.4	-	120 d	7
Hamaguchi et al[35], 2017	Japan	CT: L3-SMI	L3-SMI < 40.31 cm2/m2 in men and < 30.88 cm2/m2 in women	250	54.00 ± 14.07	44.8	33.0	22.7 ± 3.63	5 yr	8
Irwin et al[36], 2021	South Africa	CT: L3-SMI	L3-SMI < 39 cm2/m2 for women and < 50 cm2/m2 for men	106	-	60.4	-	-	1 yr	9
Tan et al[14], 2022	China	CT: L3-PMI	L3-PMI < 6.25 cm2/m2 for man	70	41.60 ± 9.70	100.0	-	22.9 ± 2.9	10 yr	8
Masuda et al[37], 2014	Japan	CT: L3-PMA	< 800 cm2 for men and < 380 cm2 for women	204	54.32 ± 9.60	50.49	-	23.6 ± 3.4	8 yr	7
Miarka et al[38], 2021	Poland	CT: L3-SMI	L3-SMI < 50 cm2/m2 for men and 39 cm2/m2 for women	98	55.00 ± 8.00	76.5	26.5	27 ± 4	1224 d	7
Montano-Loza et al[39], 2014	Canada	CT: L3-SMI	L3-SMI ≤ 41 cm2/m2 for women and ≤ 53 cm2/m2 for men with a BMI ≥25 kg/m2 and L3 SMI ≤ 43 cm2/m2 for patients with a BMI < 25 kg/m2	248	55.00 ± 1.00	68.0	39.0	27.19 ± 2.23	5 yr	9
Kalafateli et al[23], 2017	United Kingdom	CT: L3-PMI	L3-PMI < 340 mm2/m2 for men and < 264 mm2/m2 for women	232	54.00 ± 12.00	69.8	25.0	25 ± 6.43	1 yr	8
Czigany et al[40], 2020	Germany	CT: L3-SMI	L3-SMI < 50 cm2/m2 in men and < 39 cm2/m2 in women	225	54.00 ± 12.00	66.7	28.0	27 ± 5	90 d	8
Hey et al[41], 2022	Australia	DEXA: APLM	APLM < 7.26 kg/m2 for male and < 5.5 kg/m2 for female	469	55.00 ± 10.59	72.1	26.0	-	1 yr	8
Lindqvist et al[42], 2019	Sweden	CT: L3-SMI	L3-SMI < 43 cm2/m2 for men with BMI < 25 kg/m2 and < 53 cm2/m2 for BMI > 25 kg/m2 and < 41 cm2/m2 for women in all BMI ranges	53	57.00 ± 11.11	69.8	52.8	25.1 ± 5.3	1 yr	8
Riccardo et al[43], 2019	Japan	CT: L3-SMI	L3-SMI < 42 cm2/m2 for men and L3-SMI < 38 cm2/m2 for women	138	57.00 ± 13	56.5	-	24.8 ± 5	10 yr	8
Andrea et al[21], 2013	United States	CT: L3-4 SMI	L3-4 SMI ≤ 38.5 cm2/m2 for women and ≤ 52.4 cm2/m2 for men	338	55.00 ± 10.00	65.9	-	28 ± 6	1021.2 d	9
Young et al[44], 2018	Korea	CT: L3-PMTH	L3-PMTH < 15.5 mm/m	92	53.33 ± 5.75	67.4	100.0	24.17 ± 2.81	36 months	8
Hassan et al[45], 2022	Egypt	CT: L3-SMI	L3-SMI < 52.4 cm2/m2 for male and < 38.5 cm2/m2 for female	61	48.70 ± 12.50	75,4	-	23.9 ± 3.9	6 months	7

HCC: Hepatocellular carcinoma; NOS: Newcastle–Ottawa Scale; L3: The caudal end of the third lumbar vertebra; L3-SMI: Third lumbar-skeletal muscle index; PMA: The Area of the Psoas Muscle; PMTH: The psoas muscle thickness to height ratio; PSMI: Paraspinal muscle index; APLM: Appendicular lean mass; PMI: Psoas muscle index.

Table 2 The pooled overall prevalence of sarcopenia in study subgroups

Subgroup	Studies (n)	Sarcopenia (n)	Prevalence [% (95%CI)]	I2 (%)	P value
Definition of sarcopenia
L3-SMI	15	1562	41.5 (29.6-53.9)	98.6	< 0.001a
L3-PMI	4	139	36.4 (16.2-59.5)	95.6	< 0.001a
Others	6	538	41.5 (26.7-57.1)	97.0	< 0.001a
Sex
Male	17	1280	43.3 (31.1-55.9)	98.9	< 0.001a
Female	15	366	33.1 (21.6-45.6)	95.7	< 0.001a
World region
Europe	6	458	37.7 (26.6-49.5)	94.0	< 0.001a
Asia	10	734	38.8 (23.3-55.5)	98.3	< 0.001a
North America	5	661	47.8 (33.4-62.4)	96.7	< 0.001a
Africa	2	96	57.6 (50.0-65.1)	0.0	< 0.001a
Disease types
Viral	8	407	32.3 (18.9-47.2)	97.0	< 0.001a
ALD	11	477	52.2 (36.2-68.2)	96.8	< 0.001a
NAFLD	5	54	47.2 (25.7-68.6)	85.6	< 0.001a
AIH/PSC/PBC	4	141	33.6 (19.0-48.2)	63.5	0.042a
HCC	10	399	35.9 (18.6-53.2)	98.4	< 0.001a
Other	7	123	41.2 (22.6-59.8)	92.2	< 0.001a
Child-Pugh class
A	4	121	30.4 (26.0-35.0)	44.6	0.144
B	5	157	38.9 (30.8-47.0)	56.8	0.055
C	7	446	54.3 (43.9-64.8)	88.2	< 0.001a

^aP value < 0.05.

L3-SMI: Third lumbar-skeletal muscle index; L3-PMI: Third lumbar- psoas muscle index; ALD: Alcoholic liver disease; NAFLD: Nonalcoholic fatty liver disease; AIH: Autoimmune hepatitis; PSC: Primary sclerosing cholangitis; PBC: Primary biliary cholangitis; HCC: Hepatocellular carcinoma.

Table 3 Pooled 90 d and 1, 3, and 5-year cumulative survival probabilities in patients with and without sarcopenia

Survival [% (95%CI)]	With sarcopenia	Without sarcopenia	P value
90-day	92.9 (88.9-96.9), 5 studies 422 patients	96.5 (94.7-98.3), 5 studies 891 patients	0.289
1-year	79.8 (72.8-86.8), 10 studies 894 patients	92.7 (90.2-95.2), 10 studies 3475 patients	0.015a
3-year	74.3 (68.0-80.5) 4 studies 185 patients	93.4 (90.6-96.2) 4 studies 291 patients	0.003a
5-year	63.6 (56.5-70.6) 8 studies 730 patients	79.5 (73.2-85.8) 8 studies 1316 patients	0.006a

^aP value < 0.05.

The P value was produced using the random-effects meta-regression method.