Association between computed tomography-based adipose tissue parameters and liver transplant outcomes in patients with hepatocellular carcinoma.

[BACKGROUND & AIMS] The prognostic value of skeletal muscle in liver transplant recipients with hepatocellular carcinoma (HCC) has been documented; however, the role of adipose tissue remains ambiguous. This study aimed to evaluate the association between adipose tissue and transplant outcomes in patients with HCC.

[METHODS] A total of 765 patients with HCC who underwent liver transplantation (LT) at 3 transplant centers were included in this retrospective study. Computed tomography (CT) scans were utilized to quantify the area and radiodensity of visceral and subcutaneous adipose tissue. Cut-off values for adipose tissue parameters were determined based on tertiles. The Cox proportional hazards models were established to identify the predictors of overall survival (OS) and tumor recurrence.

[RESULTS] Median age at transplant was 53 years, most were male (89.0 %) and cirrhotic (91.7 %). The median follow-up was 40.3 months. In univariate survival analysis, patients with high subcutaneous adipose tissue radiodensity (SATr) (>-86.5 HU) exhibited significantly lower 5-year OS rates than those with low SATr (49.9 % vs. 65.3 %, P < 0.001). Adjusted analyses revealed that high SATr independently predicted increased mortality (HR, 1.498; 95 % CI, 1.175-1.909; P = 0.001). SATr significantly increased during the first month postoperatively (P < 0.001), with one-third of the patients exhibiting an SATr change rate exceeding 10 %. An increase in SATr >10 % was independently associated with poorer OS (HR, 1.549; 95 % CI, 1.095-2.190; P = 0.013) and higher recurrence risk (HR, 1.776; 95 % CI, 1.242-2.540; P = 0.002).

[CONCLUSION] Higher preoperative SATr was an independent predictor of patient mortality after LT for HCC. Postoperatively, a SATr increase >10 % during the first month was independently associated with elevated risk of mortality and tumor recurrence.