{
  "abstract": "Background: Alterations in body composition have been linked to both perioperative and long-term outcomes that cause orthotopic liver transplantation (OLT). Nevertheless, the potential predictive role of recipient bone mineral density (BMD) in clinical outcomes following OLT remains uncertain. In this study, we aimed to explore the role of BMD as a prognostic factor in patients undergoing OLT after brain death donation, in the context of long-term outcome. Methods: A total of 480 patients who underwent OLT during the period from 2010 to 2023 at the University Hospital RWTH Aachen were included in the retrospective analysis. Preoperative computed tomography-based segmentation was used to measure BMD at the level of the 11th thoracic vertebra. Osteopenia was defined based previously described sex-specific cutoffs. Perioperative complications were assessed by Clavien–Dindo (CD) classification and comprehensive complication index (CCI). Survival was analyzed using Kaplan–Meier estimates and uni- and multivariable Cox regression. Results: In our cohort, osteopenia was highly prevalent (48%). Patients with osteopenia exhibited significantly inferior overall survival (log-rank p < 0.001, observed median follow-up 52 months [14–97] vs. 59 months [18–101]) and impaired graft survival (log-rank p = 0.037, observed median follow-up 50 months [13–97] vs. 52 months [14–96]). In our multivariable model, osteopenia was confirmed as an independent risk-factor for inferior overall survival (HR 1.602, 95% CI 1.113–2.306; p = 0.011) and inferior graft survival (HR 1.379, 95% CI 1.018–1.870; p = 0.038). Furthermore, patients suffering from osteopenia required more perioperative red blood cell units (8 [4–13] vs. 6 [3–10], p = 0.027). No significant differences in perioperative complications were observed between osteopenic and non-osteopenic patients. Conclusion: The presence of osteopenia may represent an easily assessable marker associated with long-term outcome in patients undergoing OLT after brain death donation, thus underlining the predictive significance of body composition in this context. Further research is warranted to validate these findings.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Surgery and Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany",
    "Ajmera Transplant Centre, Toronto General Hospital, Toronto, ON M5G 2N2, Canada",
    "Department of Transplantation, Division of General Surgery, University Health Network, Toronto, ON M5G 2C4, Canada",
    "Toronto Centre for Liver Diseases, Toronto General Hospital, Toronto, ON M5G 2C4, Canada",
    "Institute of Radiology, Faculty of Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany",
    "Department of Internal Medicine III, Faculty of Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Esref Belger"
    },
    {
      "affs": [
        0
      ],
      "name": "Julian Palzer",
      "orcid": "0000-0002-5457-7628"
    },
    {
      "affs": [
        0
      ],
      "name": "Anjali A. Roeth",
      "orcid": "0000-0002-1670-7487"
    },
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Clara Antonia Weigle"
    },
    {
      "affs": [
        0,
        3
      ],
      "name": "Bengt Arne Wiemann",
      "orcid": "0009-0002-9968-5785"
    },
    {
      "affs": [
        4
      ],
      "name": "Robert Siepmann"
    },
    {
      "affs": [
        5
      ],
      "name": "Tony Bruns",
      "orcid": "0000-0002-5576-6914"
    },
    {
      "affs": [
        5
      ],
      "name": "Verena Keitel-Anselmino"
    },
    {
      "affs": [
        0
      ],
      "name": "Felix Oldhafer"
    },
    {
      "affs": [
        0
      ],
      "name": "Oliver Beetz"
    },
    {
      "affs": [
        0
      ],
      "name": "Thomas Vogel",
      "orcid": "0000-0002-3275-7329"
    },
    {
      "affs": [
        0
      ],
      "name": "Florian W. R. Vondran"
    },
    {
      "affs": [
        0
      ],
      "name": "Iakovos Amygdalos",
      "orcid": "0000-0002-5138-4214"
    },
    {
      "affs": [
        0
      ],
      "name": "Franziska A. Meister",
      "orcid": "0000-0002-9624-6042"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fw1gt835wsmzt.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15218659",
  "fulltext_url": null,
  "id": "fw1gt835wsmzt",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/21/8659",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-06",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/fw1gt835wsmzt.ris",
  "sources": [
    {
      "first_seen": "2026-11-07T00:21:23Z",
      "native_id": "10.3390/jcm15218659",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/21/8659"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
    }
  ],
  "title": "Osteopenia Is Associated with Inferior Survival After Deceased-Donor Liver Transplantation",
  "title_text": "Osteopenia Is Associated with Inferior Survival After Deceased-Donor Liver Transplantation",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T00:23:02Z",
  "url": "https://research.draconitic.com/paper/fw1gt835wsmzt",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}