{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T21:43:54Z","timestamp":1793828634884,"version":"4.6.1"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>Sarcopenic obesity is associated with higher rates of morbidity and mortality than seen with either sarcopenia or obesity alone. We aimed to define sarcopenic visceral obesity (SVO) using CT-quantified skeletal muscle index and visceral-to-subcutaneous adipose tissue ratio and to examine its association with waitlist mortality in patients with cirrhosis. Included were 326 adults with cirrhosis awaiting liver transplantation in the ambulatory setting with available abdominal CT within 6 months from enrollment between February 2015 and January 2018. SVO was defined as patients with sarcopenia (skeletal muscle index &lt;50\u00a0cm<jats:sup>2<\/jats:sup>\/m<jats:sup>2<\/jats:sup> in men and &lt;39\u00a0cm<jats:sup>2<\/jats:sup>\/m<jats:sup>2<\/jats:sup> in women) and visceral obesity (visceral-to-subcutaneous adipose tissue ratio \u22651.21 in men and \u22650.48 in women). The percentage who met criteria for sarcopenia, visceral obesity, and SVO were 44%, 29%, and 13%, respectively. Cumulative incidence of waitlist mortality was higher in patients with SVO compared to patients with sarcopenia without visceral obesity or visceral obesity without sarcopenia at 12 months (40% vs. 21% vs. 12%) (overall logrank <jats:italic toggle=\"yes\">p<\/jats:italic>=0.003). In univariable Cox regression, SVO was associated with waitlist mortality (HR: 3.42, 95% CI: 1.58\u20137.39), which remained significant after adjusting for age, sex, diabetes, ascites, encephalopathy, MELDNa, liver frailty index, and different body compositions (HR: 2.64, 95% CI: 1.11\u20136.30). SVO was associated with increase waitlist mortality in patients with cirrhosis in the ambulatory setting awaiting liver transplantation. Concurrent loss of skeletal muscle and gain of adipose tissue seen in SVO quantified by CT may be a useful and objective measurement to identify patients at risk for suboptimal pretransplant outcomes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/lvt.0000000000000010","type":"journal-article","created":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T15:00:24Z","timestamp":1675436424000},"page":"476-484","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":20,"title":["CT-quantified sarcopenic visceral obesity is associated with poor transplant waitlist mortality in patients with cirrhosis"],"prefix":"10.1097","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1980-1807","authenticated-orcid":false,"given":"Nghiem B.","family":"Ha","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5487-1600","authenticated-orcid":false,"given":"Bo","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8243-6910","authenticated-orcid":false,"given":"Amy M.","family":"Shui","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2313-3562","authenticated-orcid":false,"given":"Chiung-Yu","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3244-4696","authenticated-orcid":false,"given":"Danielle","family":"Brandman","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2092-6380","authenticated-orcid":false,"given":"Jennifer C.","family":"Lai","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, California, USA"},{"name":"Liver Center, University of California, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,1,3]]},"reference":[{"key":"R1-20250824","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1111\/jgh.13166","article-title":"Nonalcoholic steatohepatitis is strongly associated with sarcopenic obesity in patients with cirrhosis undergoing liver transplant evaluation","volume":"31","author":"Carias","year":"2016","journal-title":"J Gastroenterol Hepatol"},{"key":"R2-20250824","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.1111\/liv.13876","article-title":"Sarcopenic obesity in cirrhosis-The confluence of 2 prognostic titans","volume":"38","author":"Eslamparast","year":"2018","journal-title":"Liver Int"},{"key":"R3-20250824","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1002\/jcsm.12039","article-title":"Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis","volume":"7","author":"Montano-Loza","year":"2016","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"R4-20250824","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cld.2020.08.001","article-title":"Obesity management of liver transplant waitlist candidates and recipients","volume":"25","author":"Brandman","year":"2021","journal-title":"Clin Liver Dis"},{"key":"R5-20250824","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1097\/MOG.0000000000000176","article-title":"Aging and liver disease","volume":"31","author":"Kim","year":"2015","journal-title":"Curr Opin Gastroenterol"},{"key":"R6-20250824","doi-asserted-by":"crossref","first-page":"2288","DOI":"10.1097\/TP.0000000000001794","article-title":"Liver transplantation in the obese cirrhotic patient","volume":"101","author":"Spengler","year":"2017","journal-title":"Transplantation"},{"key":"R7-20250824","doi-asserted-by":"crossref","first-page":"863","DOI":"10.2169\/internalmedicine.55.5676","article-title":"Sarcopenia and sarcopenic obesity are prognostic factors for overall survival in patients with cirrhosis","volume":"55","author":"Hara","year":"2016","journal-title":"Intern Med"},{"key":"R8-20250824","doi-asserted-by":"crossref","first-page":"2202","DOI":"10.1016\/j.clnu.2018.09.019","article-title":"Impact of sarcopenic obesity on outcomes in patients undergoing living donor liver transplantation","volume":"38","author":"Kamo","year":"2019","journal-title":"Clin Nutr"},{"key":"R9-20250824","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1097\/SLA.0000000000002555","article-title":"Impact of sarcopenic obesity on outcomes in patients undergoing hepatectomy for hepatocellular carcinoma","volume":"269","author":"Kobayashi","year":"2019","journal-title":"Ann Surg"},{"key":"R10-20250824","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.jhep.2015.02.031","article-title":"Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma","volume":"63","author":"Fujiwara","year":"2015","journal-title":"J Hepatol"},{"key":"R11-20250824","doi-asserted-by":"crossref","first-page":"367","DOI":"10.21037\/hbsn.2017.02.02","article-title":"Impact of sarcopenic overweight on the outcomes after living donor liver transplantation","volume":"6","author":"Hammad","year":"2017","journal-title":"Hepatobiliary Surg Nutr"},{"key":"R12-20250824","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1253\/circj.66.987","article-title":"New criteria for \u201cobesity disease\u201d in Japan","volume":"66","year":"2002","journal-title":"Circ J"},{"key":"R13-20250824","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1016\/j.jhep.2018.04.015","article-title":"Low subcutaneous adiposity associates with higher mortality in female patients with cirrhosis","volume":"69","author":"Ebadi","year":"2018","journal-title":"J Hepatol"},{"key":"R14-20250824","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1159\/000508867","article-title":"Visceral adipose tissue index and hepatocellular carcinoma are independent predictors of outcome in patients with cirrhosis having endoscopic treatment for esophageal varices","volume":"39","author":"Kimura","year":"2021","journal-title":"Dig Dis"},{"key":"R15-20250824","doi-asserted-by":"crossref","first-page":"e102","DOI":"10.1038\/ctg.2015.31","article-title":"Inclusion of sarcopenia within MELD (MELD-Sarcopenia) and the prediction of mortality in patients with cirrhosis","volume":"6","author":"Montano-Loza","year":"2015","journal-title":"Clin Transl Gastroenterol"},{"key":"R16-20250824","first-page":"115","article-title":"Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography","volume":"1998","author":"Mitsiopoulos","year":"1985","journal-title":"J Appl Physiol"},{"key":"R17-20250824","first-page":"570","article-title":"Measuring visceral adipose tissue content from contrast enhanced computed tomography","volume":"20","author":"Vehmas","year":"1996","journal-title":"Int J Obes Relat Metab Disord"},{"key":"R18-20250824","first-page":"53","article-title":"Adipose tissue volume determinations in women by computed tomography: technical considerations","volume":"10","author":"Kvist","year":"1986","journal-title":"Int J Obes"},{"key":"R19-20250824","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1097\/MCG.0b013e318293a825","article-title":"Sarcopenia as a prognostic index of nutritional status in concurrent cirrhosis and hepatocellular carcinoma","volume":"47","author":"Meza-Junco","year":"2013","journal-title":"J Clin Gastroenterol"},{"key":"R20-20250824","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1002\/hep.30828","article-title":"A North American Expert Opinion Statement on sarcopenia in liver transplantation","volume":"70","author":"Carey","year":"2019","journal-title":"Hepatology"},{"key":"R21-20250824","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1002\/lt.24750","article-title":"A multicenter study to define sarcopenia in patients with end-stage liver disease","volume":"23","author":"Carey","year":"2017","journal-title":"Liver Transpl"},{"key":"R22-20250824","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1177\/1536867X1801700415","article-title":"Estimating receiver operative characteristic curves for time-dependent outcomes: the stroccurve package","volume":"17","author":"Cattaneo","year":"2017","journal-title":"Stata J"},{"key":"R23-20250824","doi-asserted-by":"crossref","first-page":"2676","DOI":"10.1002\/sim.4509","article-title":"Classification accuracy and cut point selection","volume":"31","author":"Liu","year":"2012","journal-title":"Stat Med"},{"key":"R24-20250824","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1002\/hep.21025","article-title":"Deaths on the liver transplant waiting list: an analysis of competing risks","volume":"43","author":"Kim","year":"2006","journal-title":"Hepatology"},{"key":"R25-20250824","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1002\/lt.23618","article-title":"Increased morbidity in overweight and obese liver transplant recipients: a single-center experience of 1325 patients from the United Kingdom","volume":"19","author":"Hakeem","year":"2013","journal-title":"Liver Transpl"},{"key":"R26-20250824","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1111\/liv.13523","article-title":"Weighing the risks: Morbid obesity and diabetes are associated with increased risk of death on the liver transplant waiting list","volume":"38","author":"Kardashian","year":"2018","journal-title":"Liver Int"},{"key":"R27-20250824","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1111\/j.1399-0012.2012.01669.x","article-title":"Complications associated with liver transplantation in the obese recipient","volume":"26","author":"LaMattina","year":"2012","journal-title":"Clin Transplant"},{"key":"R28-20250824","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1111\/tri.12483","article-title":"Impact of recipient morbid obesity on outcomes after liver transplantation","volume":"28","author":"Singhal","year":"2015","journal-title":"Transpl Int"},{"key":"R29-20250824","doi-asserted-by":"crossref","first-page":"3612","DOI":"10.1016\/j.transproceed.2006.10.188","article-title":"Clinical and financial impact of obesity on the outcome of liver transplantation","volume":"38","author":"Fujikawa","year":"2006","journal-title":"Transplant Proc"},{"key":"R30-20250824","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1002\/hep.29578","article-title":"Visceral adiposity increases risk for hepatocellular carcinoma in male patients with cirrhosis and recurrence after liver transplant","volume":"67","author":"Montano-Loza","year":"2018","journal-title":"Hepatology"},{"key":"R31-20250824","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1136\/gut.2008.164053","article-title":"Visceral fat accumulation is an independent risk factor for hepatocellular carcinoma recurrence after curative treatment in patients with suspected NASH","volume":"58","author":"Ohki","year":"2009","journal-title":"Gut"},{"key":"R32-20250824","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1111\/liv.14175","article-title":"Adipopenia correlates with higher portal pressure in patients with cirrhosis","volume":"39","author":"Rodrigues","year":"2019","journal-title":"Liver Int"},{"key":"R33-20250824","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/ctr.12688","article-title":"Abdominal adiposity, body composition and survival after liver transplantation","volume":"30","author":"Terjimanian","year":"2016","journal-title":"Clin Transplant"},{"key":"R34-20250824","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1002\/hep.22350","article-title":"Visceral fat: a key mediator of steatohepatitis in metabolic liver disease","volume":"48","author":"van der Poorten","year":"2008","journal-title":"Hepatology"},{"key":"R35-20250824","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.14309\/ajg.0000000000001376","article-title":"Prehabilitation-driven changes in frailty metrics predict mortality in patients with advanced liver disease","volume":"116","author":"Lin","year":"2021","journal-title":"Am J Gastroenterol"},{"key":"R36-20250824","doi-asserted-by":"crossref","first-page":"2195","DOI":"10.1111\/ajt.17079","article-title":"Sarcopenic visceral obesity is associated with increased post-liver transplant mortality in acutely ill patients with cirrhosis","volume":"22","author":"Ha","year":"2022","journal-title":"Am J Transplant"},{"issue":"suppl 2","key":"R37-20250824","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1111\/ajt.16494","article-title":"OPTN\/SRTR 2019 Annual Data Report: Liver","volume":"21","author":"Kwong","year":"2021","journal-title":"Am J Transplant"}],"container-title":["Liver Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/LVT.0000000000000010","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T20:00:21Z","timestamp":1756065621000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/LVT.0000000000000010"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,3]]},"references-count":37,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.1097\/lvt.0000000000000010","relation":{},"ISSN":["1527-6465"],"issn-type":[{"value":"1527-6465","type":"print"}],"subject":[],"published":{"date-parts":[[2023,1,3]]},"assertion":[{"value":"2022-07-15","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-25","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}