Correlation between sarcopenia and hypertrophy of the future liver remnant in patients undergoing portal vein embolization before liver resection

Akhil Baby; Yashwant Patidar; Amar Mukund; Amol Srivastava; Niraj Kumar; Shridhar Vasantrao Sasturkar; Harsh Vardhan Tevethia; Viniyendra Pamecha

doi:10.1093/bjr/tqaf003

Correlation between sarcopenia and hypertrophy of the future liver remnant in patients undergoing portal vein embolization before liver resection

Br J Radiol. 2025 Jan 12:tqaf003. doi: 10.1093/bjr/tqaf003. Online ahead of print.

Authors

Akhil Baby¹, Yashwant Patidar¹, Amar Mukund¹, Amol Srivastava¹, Niraj Kumar¹, Shridhar Vasantrao Sasturkar², Harsh Vardhan Tevethia³, Viniyendra Pamecha²

Affiliations

¹ Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi.
² Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi.
³ Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi.

PMID: 39799514
DOI: 10.1093/bjr/tqaf003

Abstract

Objectives: To study the correlation between sarcopenia and hypertrophy of the future liver remnant(FLR) in patients undergoing portal vein embolization(PVE) before liver resection, and to assess the outcomes after resection.

Methods: This retrospective study examined patients underwent PVE from May 2012 to May 2023. Demographic, clinical and laboratory features were documented and total liver volumes(TLV) and FLR volumes were measured before and 2-4 weeks after PVE. Degree of hypertrophy(DH), percentage hypertrophy(PH) and kinetic growth rate(KGR) of the FLR were calculated. Sarcopenia was defined using the skeletal muscle index(SMI) at the L3 vertebral level. Subcutaneous adipose index(SAI), visceral adipose index(VAI), cross sectional area of psoas muscle at the largest diameter(CSPM) and L3 vertebral level mean muscle attenuation(MA) were also assessed.

Results: Forty patients were included in the analysis and the median age was 57.5(IQR 51-64) and majority were males 27/40(67.5%). Twenty two patients were non-sarcopenics and 18 were sarcopenics. All patients showed hypertrophy of FLR(p = 0.001). SMI demonstrated moderate positive correlations with DH(r = 0.46, p = 0.003), PH(r = 0.47, p = 0.002) and KGR(r = 0.44, p = 0.004). VAI showed weak positive correlations with DH(r = 0.22, p = 0.17), PH(r = 0.18, p = 0.27), and KGR(r = 0.14, p = 0.37). Pre-PVE FLR demonstrated a weak negative correlation with PH(r=-0.35, p = 0.03) and KGR(r=-0.12, p = 0.47).

Conclusions: Sarcopenia, specifically SMI, significantly correlates with FLR hypertrophy after PVE. Assessment of sarcopenia and body compartments prior to PVE could help in stratifying and treats patients with impaired FLR growth.

Advances in knowledge: This study with data spanning over 11-years, is the first in the Indian population to demonstrate a significant correlation between SMI, a marker of sarcopenia, and FLR hypertrophy following PVE.