Sarcopenia in Liver Transplantation: an Update

Abstract

Purpose of Review Patients undergoing liver transplantation (LT) are at high risk of sarcopenia and associated physical frailty. This review summarises advances in our knowledge of the definition, assessment, clinical implications and management of sarcopenia in LT. Recent Findings Sarcopenia is associated with increased mortality, morbidity, physical disability and poor quality of life both before and after LT. Assessment tools have evolved from solely relying on imaging (i.e. muscle area only) to reproducible measures of function and physical performance status (i.e. liver frailty index). The multi-faceted management of sarcopenia is heavily reliant on nutrition (protein > 1.5 g/kg/day) and exercise (combined aerobic and resistance) advice. Summary There is an increased awareness of the clinical implications, assessment tools and management for patients with sarcopenia awaiting LT. Future studies need to investigate the role of specific nutritional supplements, pharmaco-/ behavioural therapy and the long-term outcomes (e.g. survival) of reversing sarcopenia in this patient population.

Association of sex‐specific donor skeletal muscle index with surgical outcomes in living donor liver transplantation recipients

“…Sarcopenia as defined by SMI is widely regarded as a surrogate endpoint reflecting mortality, morbidity, physical disability and poor quality of life both before and after LT; accordingly, the importance of adequate nutrition and exercise therapy for multilateral management of sarcopenia has also been emphasized. 25,26 However, these previous studies mainly focused on the effect of the recipient's sarcopenia on the surgical outcomes. In contrast, our study has clinical significance as the first major investigation of the association between donor SMI and surgical outcomes such as graft failure and mortality.…”

“…Kalafateli et al 15 reported that sarcopenia in LT recipients was a predictor of post‐operative morbidity and mortality regardless of the MELD score. Sarcopenia as defined by SMI is widely regarded as a surrogate endpoint reflecting mortality, morbidity, physical disability and poor quality of life both before and after LT; accordingly, the importance of adequate nutrition and exercise therapy for multilateral management of sarcopenia has also been emphasized 25,26 . However, these previous studies mainly focused on the effect of the recipient's sarcopenia on the surgical outcomes.…”

Is Liver Frailty and functional capacity associated with severity of liver disease in patients awaiting Liver Transplantation? - A prospective Observational Study

“…Seeing to the functional capacity a possible explanation for the reduction might be related to the loss of muscle mass in cirrhosis patients; however, the reduction in functional capacity may also be caused by the decrease in mitochondrial oxidative capacity and/or the number of mitochondria in the muscle tissue. Liver Dysfunction leads to protein and fat mal-absorption and hyper catabolic state [12]. So, Energy depletion when associated with physical inactivity lead to functional deterioration and hence Body Mass Index (BMI) is also found to be reduced in pre liver Transplant Recipients.…”

Fatty Hepatocytes Induce Skeletal Muscle Atrophy In Vitro: A New 3D Platform to Study the Protective Effect of Albumin in Non-Alcoholic Fatty Liver

“…The concurrent presence of NAFLD and sarcopenia led to a far worse dysglycemia and insulin resistance [12]. Sarcopenia, in turn, is a strong predictor of poor post-liver transplant outcomes ranging from a longer hospital stay, need for mechanical ventilation, intensive care, an increased risk of infection, etc., [13,14]. The potential targetable actors or at what stage of NAFLD the loss of skeletal muscle starts the vicious circle are still matters of debate.…”