Body composition and the skeletal muscle compartment in liver transplantation: Turning challenges into opportunities

Abstract

Frailty, nutritional status, and body composition are increasingly under the spotlight of interest in various clinical scenarios including liver transplantation. To address the rapidly accumulating evidence in this field, recent European and North American practice guidelines have clearly underlined the clinical importance of nutritional status and body composition with adopting their assessment in patients with liver disease and in transplant candidates into their recommendations. While earlier reports, and therefore present guidelines, were focusing predominantly on quantitative alterations of the skeletal muscle mass (sarcopenia), recent studies have identified qualitative alterations such as intramuscular fat accumulation (myosteatosis) and sarcopenic obesity as emerging risk factors for poor clinical outcomes. In this review, the role of body composition in the context of liver transplantation will be discussed with a focus on the skeletal muscle compartment. A brief overview of current assessment modalities including their limitations, diagnostic challenges, prognostic significance, and pathophysiology are included. Possibilities to incorporate body composition parameters into clinical decision making are discussed. In addition, novel trends and remaining challenges in the therapeutic targeting of body composition and the skeletal muscle compartment are highlighted.

Osteopenia is associated with inferior survival in patients undergoing partial hepatectomy for hepatocellular carcinoma

“…Further prospective clinical trials are warranted to validate these findings and assess functional components of frailty and BC at the same time. Most pre-habilitation and enhanced-recovery programs are currently focusing on the muscle compartment, physical function measured predominantly by parameters of muscle function and fitness 5 . In the context of the present findings, an interesting direction of future research would be to develop therapeutic and pre-habilitation approaches directed specifically towards frail osteopenic patients.…”

“…1 ). Further body composition parameters related to the muscle and fat compartments including skeletal muscle index (SMI), visceral fat area (VFA), subcutaneous fat area (SFA) and visceral-to-subcutaneous fat ratio (VSR) were also assessed and reported as described previously 5 , 8 , 10 , 20 , 21 .…”

“…Over the past decade, impairment of BC, including depletion of muscle mass (sarcopenia) as well as muscle quality (myosteatosis) have been found to affect perioperative outcomes in various clinical conditions 3 – 5 . Previous studies have shown a strong association of sarcopenia with poor overall survival (OS) in patients undergoing liver resection for HCC 6 – 8 and recent studies conducted by our group detected not only a high prevalence of myosteatosis, but also an association between myosteatosis and poor perioperative outcomes in patients undergoing orthotopic liver transplantation (OLT) 9 , 10 .…”

Pathophysiological changes of the liver-muscle axis in end-stage liver disease: what is the right target?

“…A new score, called psoas muscle depletion index (PDI) is proposed, based on psoas area and predicted/estimated psoas area, to remove confounding factors such as age, gender or body weight (43). Other non-irradiating muscle mass assessment techniques exist as standard anthropometric measurements, ultrasound (US) imaging, bioelectrical impedance analysis (BIA) or dual-energy x-ray absorptiometry (DEXA) scanning but appear to be less accurate than CT (44,45).…”

Calcification of the visceral aorta and celiac trunk is associated with renal and allograft outcomes after deceased donor liver transplantation

“…Particularly, in times of critical organ shortage and consecutive rise in the use of marginal allografts from extended criteria donors (ECD), an optimal clinical risk assessment and outcome prediction in the setting of OLT is of utmost relevance [5,6]. In this context, various predictive scores have been developed to assess perioperative risk in the setting of OLT over the last decades [7,8]. These include well-established scores such as Balance of Risk (BAR) [9], Survival Outcomes Following liver Transplantation (SOFT) [10], and the Donor Risk Index (DRI) [11,12].…”