Quantifying the eyeball test: Sarcopenia, analytic morphomics, and liver transplantation

Abstract

The physiological implications of end-stage liver disease (ESLD) are so pervasive that measuring the severity of the disease is challenging and imperfect. Although the Model for End-Stage Liver Disease (MELD) score is convenient and reliable, clinicians appreciate the broad range of disease severity among patients with any given MELD score. Within this context, most MELD-based allocation systems allow exception points for patients whose risk of wait-list mortality is poorly reflected by their calculated MELD scores. In the United States, the majority of MELD exceptions are granted for objective diagnoses such as hepatocellular carcinoma and hepatopulmonary syndrome, and patients who are subjectively assessed to be ‘‘sicker than their MELD score’’ likely have increased wait-list mortality. Importantly, allocation policy and treatment algorithms work best with objective clinical assessments (eg, the MELD score), which are well suited for standardization and the rigorous modeling of predicted risk. In all, better objective measures of disease severity in patients with liver disease are needed. One such objective measure of disease severity, sarcopenia, is described by Tandon et al. 1 in this issue of Liver Transplantation. This good work has several key take-home points. First, the authors demonstrate that sarcopenia is a strong and independent predictor of mortality among patients waiting for liver transplanta