Body Composition in Liver Transplant Patients: Long‐Term Changes and Impact on Recovery Outcomes

ABSTRACT Background Sarcopenia and obesity are prevalent in end‐stage‐liver‐disease (ESLD) patients undergoing Liver Transplantation (LT), contributing to morbidity and mortality. Although LT restores liver function, sarcopenia and obesity often persist. Body mass index (BMI) is unreliable in ESLD for assessing adiposity, necessitating alternative measures. Visceral‐to‐subcutaneous adipose tissue (VAT/SAT) ratio affects outcomes, with VAT associated with poorer cardiovascular health and survival. This study investigated long‐term changes in body composition post‐LT and their associations with survival and hospital/ICU stay. Methods A single‐center retrospective cohort analyzed 81 adults undergoing LT (2009–2015). Body composition was assessed via CT/MRI at L3 level pre‐LT and longitudinally up to 10y post‐LT. Sarcopenia was defined using sex‐specific skeletal muscle index (L3‐SMI) thresholds. VAT and SAT areas quantified fat distribution. Outcomes included ICU/hospital stay and survival. Longitudinal changes were modeled using linear mixed models. Associations resulted from survival analysis and Spearman correlations. Results Pre‐LT, 61% were sarcopenic, 53% had BMI ≥ 25 kg/m 2 , and 19% had sarcopenic obesity. Post‐LT, L3‐SMI declined, partially recovered, but remained below baseline. BMI decreased initially, then increased. VAT rose for 2–4y, then declined; SAT increased steadily. VAT/SAT ratio increased modestly early, then declined after ∼4.5y. Pre‐LT sarcopenia predicted lower survival; post‐LT didn't. Higher pre‐LT VAT was associated with prolonged ICU stay. Elevated pre‐LT VAT/SAT ratio correlated with longer ICU/hospital stays. Conclusions Sarcopenia persists long after LT and is associated with reduced survival. Unfavorable fat distribution was associated with longer hospital/ICU stay. Early diagnosis and targeted management of sarcopenia and visceral adiposity seem promising to improve post‐LT outcomes.