The impact of balloon-occluded retrograde transvenous obliteration–induced hepatic hemodynamic changes on skeletal muscle: A retrospective cohort study

Background Balloon-occluded retrograde transvenous obliteration (BRTO) has garnered increasing attention for its potential to improve liver function. However, its impact on skeletal muscle remains inadequately explored. This retrospective study aimed to evaluate the effects of BRTO on skeletal muscle. Methods Among 92 patients with portal hypertension who underwent BRTO, 60 (mean age: 67 year; 38 males and 22 females) met the eligibility criteria for analysis. Pre- and post-BRTO changes in several parameters were assessed, including Child–Pugh (C-P) scores, portal vein flow volume (PV-Vo), hepatic venous pressure gradient (HVPG), skeletal muscle index (SMI), liver stiffness (LS), splenic volume (SV), liver volume (LV), and portosystemic shunt diameter (PSS-d). Patients were categorized into two groups based on changes in SMI: the increased SMI group (group I) and the nonincreased SMI group (group NI). The factors associated with SMI improvement were analyzed using logistic regression. Categorical variables were analyzed using the chi-square or Fisher’s exact test, while continuous variables were analyzed using the Mann–Whitney U test. Receiver operating characteristic curves were generated to determine optimal cutoff values. Correlations were assessed using linear regression analysis. Results Following BRTO, significant improvements were observed in serum albumin, ammonia levels, and C-P scores, along with increased HVPG and PV-Vo. Group I comprised 36 patients, while group NI included 24 patients. No significant overall changes in SMI were observed across all patients. However, in group I, PSS-d and LS were significantly lower in group NI. Additionally, ΔPV-Vo and ΔLV were significantly higher, while ΔSV was significantly lower in group I than in group NI. Univariate analysis identified ΔPV-Vo, PSS-d, and LS as significant factors contributing to SMI improvement, while multivariate analysis confirmed ΔPV-Vo as the sole significant factor, with an optimal cutoff value of 10.7% and an accuracy of 0.817. Conclusions Balloon-occluded retrograde transvenous obliteration–induced increases in portal blood volume play a crucial role in maintaining skeletal muscle mass.