Introduction: Sarcopenia has been defined as a low appendicular skeletal muscle mass (kg/m2) two standard deviations below the mean of a young healthy reference group (Baumgartner 1998) coupled with a concomitant loss of muscle function, or severe muscle depletion. Studies have shown that sarcopenic patients undergoing surgical resection diagnosed by computed tomography (CT) prior to surgery were at increased risk for perioperative infections, increased length of stay (LOS) and higher mortality (Moissy et al 2013, Weijs 2014). Sarcopenic obesity measured by CT imaging has been correlated with poorer outcomes in post living donor liver transplantation (Itoh S, 2016). In our institution, highly trained and experienced registered dietitians (RDs) assess muscle loss as part of the nutrition focused physical exam (NFPE) using the new guidelines to diagnose malnutrition set by the Academy of Nutrition and Dietetics and the American Society of Parenteral and Enteral Nutrition (White 2012). This practice, however, has yet to be validated. CT scans are an objective measurement of assessing skeletal muscle mass, and abdominal wall and visceral adipose (Gomez-Perez 2016), and may be useful in determining skeletal muscle loss.

Methods: Our team studied the correlation between malnutrition diagnosis via NFPE and muscle and fat mass on CT scans before and after intestinal transplantation. We also looked at the correlation of CT measurements with predicting post-operative morbidity and mortality.

Results: A total of 42 subjects were included in the study consisting of 31% male and 69% female patients. Sixty percent of subjects did not have any degree of malnutrition during the pre-transplant NFPE, while 40% had moderate to severe protein calorie malnutrition. We found a significant correlation between patients diagnosed with malnutrition and those without malnutrition in subcutaneous fat CT measurements during pre-transplant evaluation (p=0.037). We also found a significant correlation with LOS (p=0.005) and mortality (p=0.006) with patients who received multivisceral transplants versus all other types of transplant (isolated intestine, modified multivisceral, intestine and pancreas).

Conclusion: This study is the first of its kind to analyze malnutrition in the intestinal transplant population. Based on these results, it may be feasible to analyze CT measurements to assess recent patient nutriture to help identify patients with malnutrition prior to transplantation.