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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Osteopenia Is Associated with Inferior Survival After Deceased-Donor Liver Transplantation

  • Esref Belger1
  • Julian Palzer1
  • Anjali A. Roeth1
  • Clara Antonia Weigle1,2,3
  • Bengt Arne Wiemann1,4
  • Robert Siepmann5
  • Tony Bruns6
  • Verena Keitel-Anselmino6
  • Felix Oldhafer1
  • Oliver Beetz1
  • Thomas Vogel1
  • Florian W. R. Vondran1
2 more authors
  • Iakovos Amygdalos1
  • Franziska A. Meister1
6 affiliations
  1. 1Department of Surgery and Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany
  2. 2Ajmera Transplant Centre, Toronto General Hospital, Toronto, ON M5G 2N2, Canada
  3. 3Department of Transplantation, Division of General Surgery, University Health Network, Toronto, ON M5G 2C4, Canada
  4. 4Toronto Centre for Liver Diseases, Toronto General Hospital, Toronto, ON M5G 2C4, Canada
  5. 5Institute of Radiology, Faculty of Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany
  6. 6Department of Internal Medicine III, Faculty of Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany
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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.

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Cite

BibTeXRIS
BibTeX
@article{belger2026osteopenia,
  title = {{Osteopenia Is Associated with Inferior Survival After Deceased-Donor Liver Transplantation}},
  author = {Esref Belger and Julian Palzer and Anjali A. Roeth and Clara Antonia Weigle and Bengt Arne Wiemann and Robert Siepmann and Tony Bruns and Verena Keitel-Anselmino and Felix Oldhafer and Oliver Beetz and Thomas Vogel and Florian W. R. Vondran and Iakovos Amygdalos and Franziska A. Meister},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = nov,
  doi = {10.3390/jcm15218659},
  url = {https://www.mdpi.com/2077-0383/15/21/8659},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Osteopenia Is Associated with Inferior Survival After Deceased-Donor Liver Transplantation
AU  - Esref Belger
AU  - Julian Palzer
AU  - Anjali A. Roeth
AU  - Clara Antonia Weigle
AU  - Bengt Arne Wiemann
AU  - Robert Siepmann
AU  - Tony Bruns
AU  - Verena Keitel-Anselmino
AU  - Felix Oldhafer
AU  - Oliver Beetz
AU  - Thomas Vogel
AU  - Florian W. R. Vondran
AU  - Iakovos Amygdalos
AU  - Franziska A. Meister
PY  - 2026
DA  - 2026/11/06
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218659
UR  - https://www.mdpi.com/2077-0383/15/21/8659
AB  - 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.
SN  - 2077-0383
ER  -