Sarcopenia in Children With End-stage Liver Disease.

Background: Sarcopenia, reflected by decreased psoas muscle surface area (PMSA), has been identified as a novel and independent predictor of waitlist mortality and outcomes in adult liver transplantation (LT). We hypothesized that children with end-stage liver disease (ESLD) would have smaller PMSA than healthy controls. Methods: Images of children (0-18y) listed for LT in 2015 and a control group comprised of 2:1 age- and gender-matched healthy pediatric trauma victims were reviewed. PMSA was determined at two intervertebral disc levels (L3/4; L4/5). A subset of images was reviewed by 2 radiologists to determine inter-rater correlation. Results: 23 children with ESLD were included, and the most prevalent diagnosis was biliary atresia (61%). On both lumbar levels, median PMSA was significantly smaller in ESLD subjects compared to the 46 healthy controls (L4/5; median tPMSA 407 mm2 (IQR 339, 537) vs. Controls 513 mm2 (IQR 437, 672); p = 0.004), independent of participants' weight z-scores (r = 0.01; p = 0.95). Excellent inter-rater correlation was seen (ICC 0.99). Conclusion: In this retrospective pilot study, PMSA was significantly lower in children with ESLD compared to healthy age- and gender-matched controls. Since this finding was independent of growth in ESLD subjects, PMSA may represent a novel objective nutritional biomarker in children with advanced liver disease. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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