Improving the prognosis before and after liver transplantation: Is muscle a game changer?

Abstract

Liver transplantation (LT) is currently the only curative treatment option for selected patients with end stage liver disease or hepatocellular carcinoma. Improving waiting list-mortality, post-transplant morbidity and mortality and refining the selection of the patients remain our current central objectives. In this field, different concepts dealing with nutrition and the muscle such as sarcopenia, malnutrition, frailty or myosteatosis have emerged as possible game changers. For more than a decade, many prospective studies have demonstrated that sarcopenia and frailty are major predictive factors of mortality in the waiting list but also after LT. Malnutrition is also a well-known risk factor for morbidity and mor-tality. Muscle composition is a newer concept giving insight on muscle quality which has also been shown to be linked to poorer outcomes. Each of these terms has a precise definition as well as pathophysiological mechanisms. The bi-directional liver-muscle axis makes sense in this situation. Defining the best, easy to use in clinical practice tools to assess muscle quality, quantity, and function in this specific population and developing quality prospective studies to identify interventional strategies that could improve these parameters as well as evaluate the effect on mortality are among the important challenges of today.

Myosteatosis: Diagnosis, pathophysiology and consequences in metabolic dysfunction-associated steatotic liver disease

“…Sarcopenia is defined by a loss of muscle mass and function while myosteatosis is defined by an excessive muscle lipid content. 12 , 13 Myosteatosis is frequent in cirrhosis and hepatic encephalopathy. 14 While pathophysiological mechanisms linking hepatic encephalopathy and sarcopenia have been investigated deeply, 15 the role of ammonia in the pathogenesis of myosteatosis is unknown.…”

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

“…This term relates to an entire spectrum of physical and functional abnormalities including loss of muscle mass and reduced physical function (sarcopenia). These changes have a major impact on clinical outcomes in ESLD but also in post-liver transplant (LT) outcomes (2)(3)(4)(5)(6)(7). Indeed, muscle changes such as sarcopenia in ESLD are correlated to increased all-cause mortality rates independently of liver disease etiology (7,8).…”

“…These changes have a major impact on clinical outcomes in ESLD but also in post-liver transplant (LT) outcomes (2)(3)(4)(5)(6)(7). Indeed, muscle changes such as sarcopenia in ESLD are correlated to increased all-cause mortality rates independently of liver disease etiology (7,8). Data are also sometimes available for the common causes of chronic liver disease (CLD), namely alcohol-related liver disease (ALD), metabolic dysfunction-associated fatty liver disease (MAFLD) also called non-alcoholic fatty liver disease (NAFLD) and chronic viral hepatitis (9,10).…”

“…This myosteatosis appeared in the absence of sarcopenia (66-68). In the general population, both sarcopenia and myosteatosis are associated with increased mortality (7,69).…”

Clinical nutrition, skeletal muscle and liver disease: linking the dots for good management

“…He stresses the importance of simple measures to combat sarcopenia, and calls for a combined approach of physical exercise and nutritional management with the aim of finally achieving significant results on posttransplant survival (12). What also emerges from these manuscripts is that, more than myopenia or sarcopenia, it is also myosteatosis that reflects the severity of the liver disease and represents a potential target (10)(11)(12)(13).…”