Patient selection: liver transplant recipient from a living donor
Parameters:
(1) MELD score
(2) IMAC (muscle quality): intramuscular adipose tissue content
(3) PMI (muscle mass) in square cm divided by height squared in meters: psoas muscle mass index
(4) sex
IMAC is determined on a CT scan by dividing the Hounsfield units of multifidus muscles at L3 by that of subcutaneous fat. A high IMAC indicates more adipose tissue and lower muscle quality.
PMI is determined from the cross-sectional areas of the left and right psoas muscles at L3 in the CT scans. The area is normalized by dividing by the square of the height in meters.
|
Parameter
|
Finding
|
Points
|
|
MELD
|
|
MELD
|
|
IMAC
|
<= -0.375 and male
|
0
|
|
|
> -0.375 and male
|
27
|
|
|
<= -0.234 and female
|
0
|
|
|
> -0.234
|
27
|
|
PMI
|
>= 6.51 and male
|
0
|
|
|
< 6.51 and male
|
25.2
|
|
|
>= 3.928 and female
|
0
|
|
|
< 3.928 and female
|
25.2
|
muscle MELD =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: over 85.
• The median score was 42.
• A cutoff value of 43.2 was identified from ROC curve analysis.
• The overall survival after transplant was lower in patients with an elevated muscle-MELD.
Performance:
• The area under the ROC curve for 12-month survival was 0.78.
