肌肉减少症与因肝细胞癌 (HCC) 接受肝移植 (LT) 的患者的长期生存不良相关。然而，肌脂肪变性和肌肉损失对患者预后的影响尚未得到研究。纳入了在 3 个移植中心接受 LT 的 756 名 HCC 患者。收集受者的计算机断层扫描（CT）图像以测量骨骼肌指数（SMI）和骨骼肌放射密度（SMRA）。分别研究了肌脂肪变性对肌少症和非肌少症患者预后的影响。根据肌肉减少症和肌脂肪变性的存在来评估肌肉状态。 342 名男性的肌肉损失计算为 LT 评估前后 SMI 的相对变化。 Cox 回归模型用于确定总生存期 (OS) 和无复发生存期 (RFS) 的预测因素。该研究包括 673 名男性和 83 名女性。中位随访时间为 31 个月（四分位数范围，19-43 个月）。在 LT 之前，分别有 267 名 (39.7%) 和 187 名 (27.8%) 男性被定义为肌肉减少症 (低 SMI) 和肌脂肪变性 (低 SMRA)。对于肌肉减少症患者，出现肌脂肪变性后，5 年 OS 下降 23.6%（P < 0.001），5 年 RFS 下降 15.0%（P = 0.014）。单变量和多变量分析显示，肌肉状态是 OS 的独立预测因子[风险比 (HR)，1.569； 95%置信区间（CI），1.317-1.869； P < 0.001] 和 RFS（HR，1.369；95% CI，1.182-1.586；P < 0.001）。术后，肌肉损失 >14.2% 是 OS 不良（HR，2.286；95% CI，1.358-3.849；P = 0.002）和 RFS（HR，2.219；95% CI，1.418-3.471；P < 0.001) 在非肌肉减少症受者 (N = 209) 中。移植前肌脂肪变性加剧了肌肉减少症对男性 HCC 患者肝移植结果的不利影响。移植后肌肉损失可能有助于在没有预先存在肌肉减少症的情况下对受者进行预后分层，从而激发对个体化管理的新见解。© 2024 作者。 《恶病质、肌肉减少症和肌肉杂志》由 Wiley periodicals LLC 出版。

Sarcopenia is associated with unfavourable long-term survival in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC). However, the impact of myosteatosis and muscle loss on patient prognosis has not been investigated.Seven hundred fifty-six HCC patients who received LT at 3 transplant centres were included. Computed tomography (CT) images of recipients were collected to measure skeletal muscle index (SMI) and skeletal muscle radiodensity (SMRA). The impact of myosteatosis on the prognosis of sarcopenic and non-sarcopenic patients was studied separately. Muscle status was evaluated based on the presence of sarcopenia and myosteatosis. The muscle loss of 342 males was calculated as the relative change of SMI between pre- and post-LT evaluations. Cox regression models were used to identify predictors of overall survival (OS) and recurrence-free survival (RFS).The study comprised 673 males and 83 females. The median follow-up time was 31 months (interquartile range, 19-43 months). Prior to LT, 267 (39.7%) and 187 (27.8%) males were defined as sarcopenic (low-SMI) and myosteatotic (low-SMRA), respectively. For sarcopenic recipients, the presence of myosteatosis was followed by a 23.6% decrease in 5 year OS (P < 0.001) and a 15.0% decrease in 5 year RFS (P = 0.014). Univariate and multivariate analyses revealed that muscle status was an independent predictor of OS [hazard ratio (HR), 1.569; 95% confidence interval (CI), 1.317-1.869; P < 0.001] and RFS (HR, 1.369; 95% CI, 1.182-1.586; P < 0.001). Postoperatively, a muscle loss >14.2% was an independent risk factor for poor OS (HR, 2.286; 95% CI, 1.358-3.849; P = 0.002) and RFS (HR, 2.219; 95% CI, 1.418-3.471; P < 0.001) in non-sarcopenic recipients (N = 209).Pre-transplant myosteatosis aggravated the adverse impact of sarcopenia on liver transplant outcomes in male HCC patients. Post-transplant muscle loss might assist in prognostic stratification of recipients without pre-existing sarcopenia, intriguing new insights into individualized management.© 2024 The Author(s). Journal of Cachexia, Sarcopenia and Muscle published by Wiley Periodicals LLC.