Both sarcopenia and frailty determine suitability of patients for liver transplantation—A systematic review and meta‐analysis of the literature

Abstract

Liver grafts are allocated based on both urgency and utility. Due to a tremendous shortage of suitable organs for liver transplantation (LT), a careful selection of suitable recipients is of utmost importance. While the sickest first principle for organ allocation based on MELD score goes along with poor utility, other parameters reflecting the general health condition like frailty and sarcopenia might be essential to detect suitable patients for the waiting list. Thus, this study was designed to evaluate both frailty and sarcopenia in LT. A systematic review of the literature on sarcopenia and frailty measurements in liver transplant recipients was performed. Thirteen of 238 studies were selected for full paper review. Six of the studies investigating the impact of frailty on waitlist mortality were subjected to a meta-analysis. Despite the different methodologies to assess sarcopenia, reports showed that sarcopenia was highly related to waitlist mortality with a sum of all that highly favored negative outcome in case of sarcopenia. The existing literature clearly underlines that frailty and sarcopenia are important to determine in LT candidates. One unique index for transplant candidates reflecting frailty should be developed and be used as a standard in all transplant centers to facilitate comparability.

Characteristics of sarcopenia by European consensuses and a phenotype score

“…Sarcopenia is associated with falls, functional impairment, and mortality in community‐dwelling older adults . Because muscle mass and function reflect physiological reserve, these parameters also associated with poor outcomes in patients receiving stressful treatments, such as cancer chemotherapy, organ transplantation, and cardiovascular procedures . Based on these evidences, the Centers for Medicare and Medicaid Services and the National Center for Health Statistics included sarcopenia as a disease in the International Classification of Diseases, 10th Revision, Clinical Modification in 2016 …”

Frailty Assessment in Patients with Liver Cirrhosis

“…According to United Network for Organ Sharing (UNOS), the Model for End‐Stage Liver Disease (MELD) score measures liver disease severity and is currently used to prioritize organ allocation to candidates based on life expectancy over the next three months. However, this score does not take into consideration a patient's overall health and has been proved to be a poor predictor of posttransplant mortality . Factors such as frailty are not considered in the MELD score, yet have been associated with longer length of stay (LOS), increased number of hospitalizations, and wait‐list mortality …”

“…In a study with 53 patients with cirrhosis, up to 76% of waking hours were spent sedentary . A sedentary lifestyle is recognized as a leading predictor of morbidity and mortality, and the risk is elevated in patients with cirrhosis because of the presence of malnutrition, decreased hepatic protein synthesis, hypermetabolism, and inflammatory cytokines . Implementation of an exercise program is recommended by the American College of Sports Medicine for the management of people with chronic disease, specifically those who are awaiting LT.…”

Liver transplantation for hepatocellular carcinoma - non-cancer factors and implications for improving outcome beyond standard tumor criteria

“…It seems to be a response to protein-energy malnutrition, metabolic catabolism, and patients' inactivity [59,60] . Although there is currently no worldwide standard measurement and index of sarcopenia, depletion of skeletal muscle mass and function estimated by crosssectional abdominal imaging were demonstrated to be a significant risk factor for wait list mortality, prolonged intensive care duration, complicated hospital stay, severe infections, metabolic syndrome and overall poor outcome in liver recipients, independent from underlying indication [57,[61][62][63] .…”