{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:06:33Z","timestamp":1788930393761,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:00:00Z","timestamp":1788566400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Sarcopenia adversely affects outcomes after liver transplantation. The CT-based skeletal muscle index (SMI) is a validated prognostic measure but requires dedicated image analysis. We evaluated the diagnostic performance of creatinine\/cystatin C-based serum muscle indices for identifying CT-defined sarcopenia and their prognostic value for graft failure in living donor liver transplantation (LDLT) recipients. Methods: We retrospectively analyzed 802 LDLT recipients (January 2023\u2013April 2026). Using serum creatinine- and cystatin C-based equations, we calculated total body muscle mass (TBMM), appendicular skeletal muscle mass (ASM), and predicted SMI, and derived height-squared-normalized indices (TBMMI, ASMI); the creatinine-to-cystatin C ratio served as a non-equation-based comparator. CT-defined sarcopenia was classified using sex-specific reference cutoffs (males &lt; 39.9, females &lt; 28.9 cm2\/m2). Diagnostic accuracy was assessed with sex-stratified ROC curves and DeLong test. The primary outcome was graft failure (recipient death or re-transplantation); its association with the best-performing index at 180 days, 1 year, and 3 years was evaluated using multivariable Cox models. Results: TBMMI showed the strongest correlation with SMI (r = 0.75). TBMMI discriminated CT-defined sarcopenia well (AUC 0.845 in males, 0.828 in females). After multivariable adjustment, each 1 kg\/m2 decrease in TBMMI was independently associated with graft failure at 180 days (adjusted hazard ratio [HR] 1.42, 95% CI, 1.14\u20131.78), 1 year (HR 1.28, 1.05\u20131.56), and 3 years (HR 1.20, 1.02\u20131.40) (all p &lt; 0.05). Conclusions: TBMMI is an accessible, non-imaging surrogate for SMI in LDLT recipients, and a lower TBMMI is independently associated with postoperative graft failure.<\/jats:p>","DOI":"10.3390\/jcm15176889","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T12:12:25Z","timestamp":1788783145000},"page":"6889","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Serum Creatinine\/Cystatin C-Based Muscle Indices for Sarcopenia and Graft Failure After Living Donor Liver Transplantation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6082-2474","authenticated-orcid":false,"given":"Sa-Jin","family":"Kang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8697-7055","authenticated-orcid":false,"given":"Yan Zhen","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9215-735X","authenticated-orcid":false,"given":"Yu Sub","family":"Sung","sequence":"additional","affiliation":[{"name":"Clinical Research Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8599-7097","authenticated-orcid":false,"given":"Hyeun-Joon","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6643-9177","authenticated-orcid":false,"given":"Kyoung-Sun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye-Mee","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1225-1793","authenticated-orcid":false,"given":"In-Gu","family":"Jun","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6076-6978","authenticated-orcid":false,"given":"Jun-Gol","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3627-1107","authenticated-orcid":false,"given":"Gyu-Sam","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment","volume":"21","author":"Chen","year":"2020","journal-title":"J. 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