Systematic Review and Meta-Analysis of the Impact of Computed Tomography–Assessed Skeletal Muscle Mass on Outcome in Patients Awaiting or Undergoing Liver Transplantation

Vugt, Jeroen L.A. van; Levolger, Stef; Bruin, Ron W. F. de; Rosmalen, Joost van; Metselaar, Herold J.; IJzermans, Jan N.M.

doi:10.1111/ajt.13732

Cited by 291 publications

(260 citation statements)

References 45 publications

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“…As muscle wasting and malnutrition are often clinically evident in Child Pugh C patients and therefore may not require specialized testing for diagnosis, it is likely that bedside tools will have the most diagnostic relevance in Child Pugh A and B patients. The majority of studies evaluating sarcopenia in cirrhosis have utilized CT scans 34 , whereas most patients in our study had MRI based evaluation. As CT carries with it the risks of radiation and contrast exposure, MRI may be a preferred cross-sectional imaging modality in cirrhosis.…”

Section: Use Of the Subjective Global Assessment (Sga) In Cirrhosismentioning

confidence: 99%

A Model to Identify Sarcopenia in Patients With Cirrhosis

Tandon

Low

Mourtzakis

et al. 2016

Clinical Gastroenterology and Hepatology

189

195

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Section: Use Of the Subjective Global Assessment (Sga) In Cirrhosismentioning

confidence: 99%

A Model to Identify Sarcopenia in Patients With Cirrhosis

Tandon

Low

Mourtzakis

et al. 2016

Clinical Gastroenterology and Hepatology

189

195

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“…Some of these reports suggest that sarcopenia adds to the prognostic value of the MELD scoring system[40, 53]. The cause(s) of higher mortality is however not as evident though both increased risk of infection and encephalopathy may be contributory factors[54]. Sarcopenia may also impair diaphragmatic work due to reduced muscle mass and this event may favor pulmonary complications especially in the context of surgery (liver resection or liver transplantation).…”

Section: Clinical Impact Of Sarcopenia In Cirrhosismentioning

confidence: 99%

Sarcopenia from mechanism to diagnosis and treatment in liver disease

Dasarathy

Merli

2016

Journal of Hepatology

482

611

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Sarcopenia or loss of skeletal muscle mass is the major component of malnutrition and is a frequent complication in cirrhosis that adversely affects clinical outcomes including survival, quality of life, development of other complications and post liver transplantation survival. Radiological image analysis is currently used to diagnose sarcopenia in cirrhosis. Nutrient supplementation and physical activity are used to counter sarcopenia but have not been consistently effective because the underlying molecular and metabolic abnormalities persist or are not influenced by these treatments. Even though alterations in food intake, hypermetabolism, alterations in amino acid profiles, endotoxemia, accelerated starvation and decreased mobility may all contribute to sarcopenia in cirrhosis, hyperammonemia as a possible mediator of the liver-muscle axis has recently gained attention Increased muscle ammonia causes: cataplerosis of α-ketoglutarate, increased transport of leucine in exchange for glutamine, impaired signaling by leucine, increased expression of myostatin, a TGFβ superfamily member and an increased phosphorylation of eukaryotic initiation factor 2α, mitochondrial dysfunction, increased reactive oxygen species that decrease protein synthesis and increased autophagy mediated proteolysis. These molecular and metabolic alterations may contribute to the anabolic resistance and inadequate response to nutrient supplementation in cirrhosis. Central and skeletal muscle fatigue contributes to impaired exercise capacity and responses. Use of proteins with low ammoniagenic potential, leucine enriched amino acid supplementation, long term ammonia lowering strategies and a combination of resistance and endurance exercise to increase muscle mass and function may target the molecular abnormalities in the muscle. Strategies targeting endotoxemia and the gut microbiome need further evaluation.

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“…The meta-analysis by van Vugt and colleagues highlights the independent prognostic value of computed tomography (CT) in evaluating sarcopenia as a predictor of preand posttransplant mortality in cirrhosis (1). These data provide strong evidence for using cross-sectional imaging-based surveillance as an objective diagnostic and prognostic tool in identifying sarcopenia in patients with cirrhosis.…”

Section: Comparing the Variability Between Measurements For Sarcopenimentioning

confidence: 99%