ORIGINAL RESEARCH article
Front. Surg.
Sec. Visceral Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1671709
This article is part of the Research TopicThe Evolving Role of Liver Transplantation for the treatment of Malignant Tumors: Current Perspectives and Future DirectionsView all 4 articles
Impact of Low Preoperative Appendicular Skeletal Muscle Mass on Postoperative Complications and Short-Term Outcomes in Liver Transplant Recipients: A Propensity Score-Matched Retrospective Study
Provisionally accepted
jing xu
QIAN WUfeng xiao xuhong fei wengtao lvjian yangping shou wangrui libo ai chen
Gang Xu
yin jia yang*nan lv yan- West China Hospital, Sichuan University, Chengdu, China
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Background Low preoperative appendicular skeletal muscle mass (ASM) is common in liver transplantation (LT) recipients and may be linked to adverse postoperative outcomes. This study explored the relationship between preoperative ASM and short-term postoperative outcomes, including perioperative inflammation. Methods We retrospectively analyzed 653 LT patients at West China Hospital from 2015 to 2022. ASM index (ASM/H²) was calculated using Asian Working Group for Sarcopenia (AWGS) standards. Patients were classified into low and non-low ASM groups by sex-specific cutoffs. Propensity score matching (PSM, 1:1) was used to control for confounding. Associations with complications, inflammatory markers, and survival were evaluated using multivariate logistic and Cox regression. The predictive performance was evaluated using receiver operating characteristic (ROC) curves. Results After PSM, 84 matched pairs were analyzed. On postoperative days 1 and 3, the low ASM group had significantly higher neutrophils, NLR, MLR, and NMR (P < 0.05), and lower lymphocyte and platelet counts. This group also showed increased early complications, including pulmonary infection, pleural effusion, and intra-abdominal bleeding (in-hospital mortality: 9.52% vs. 1.19%, P = 0.040). Low ASM independently predicted complications (OR = 6.61, 95% CI: 3.08–14.21) and worse overall survival (HR = 2.25, 95% CI: 1.41–3.57). Predictive models including ASM achieved high accuracy (AUC = 0.80 for complications; AUC = 0.75 for survival). Conclusions Low preoperative ASM is an independent risk factor for inflammation, complications, and poorer survival after LT. ASM screening may improve early risk stratification and guide perioperative care.
Keywords: low Appendicular Skeletal Muscle Mass, liver transplant, Postoperative Complications, Short-term prognosis, Propensity score matching
Received: 23 Jul 2025; Accepted: 09 Sep 2025.
Copyright: © 2025 xu, WU, xu, weng, lv, yang, wang, li, chen, Xu, yang and yan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: yin jia yang, West China Hospital, Sichuan University, Chengdu, China
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