Liver transplant recipients have worse metabolic body phenotype compared with matched non-transplant controls.

Background And Aim: Quantification of body compartments, particularly the interaction between adipose tissue and skeletal muscle, is emerging as novel a biomarker of metabolic health. The present study evaluated the impact of liver transplant (LT) on body compartments.

Methods: Totally 66 adult LT recipients were enrolled in whom body compartments including visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (ASAT), muscle fat infiltration (MFI), fat-free muscle volume (FFMV), and liver fat (LF) were quantified via whole body magnetic resonance imaging (MRI). To provide non-LT comparison, each LT recipient was matched to at least 150 non-LT controls for same sex, age, and body mass index (BMI) from the UK Biobank registry.

Results: LT recipients ( matched non-LT controls) had significantly higher subcutaneous (13.82 ± 5.47 12.10 ± 5.10 L,  < 0.001) and visceral fat (7.59 ± 3.75 6.72 ± 3.06 L,  = 0.003) and lower LF (5.88 ± 7.14 8.75 ± 6.50%,  < 0.001) and muscle volume (11.69 ± 2.95 12.12 ± 2.90 L,  = 0.027). In subgroup analysis, patients transplanted for metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis ( non-MASH cirrhosis) had higher ASAT, VAT, and MFI. A trend toward higher LF content was noted; however, this did not reach statistical significance (6.90 ± 7.35 4.04 ± 6.23%,  = 0.189). Finally, compared with matched non-LT controls, patients transplanted for MASH cirrhosis had higher ASAT and VAT; however, FFMV and MFI were similar.

Conclusion: Using non-LT controls, the current study established the higher-than-expected adiposity burden among LT recipients, which is even higher among patients transplanted for MASH cirrhosis. These findings provide data needed to design future studies developing radiomics-based risk-stratification strategies in LT recipients.