Sarcopenia in Liver Transplantation.

Abstract

Sarcopenia is highly prevalent in end-stage liver disease (ESLD) patients and has been linked to poor outcomes on the wait list and post-transplantation. This current perspectives article reviews the ongoing challenges to define sarcopenia in ESLD patients, describes associations of sarcopenia with wait-list and post-transplantation outcomes, and provides summarized data on efforts to prevent and treat sarcopenia through novel interventions. Supervised exercise programs improve muscle strength, but muscle mass outcomes are limited by short study follow-up times. Branched chain amino acid supplementation may ameliorate sarcopenia in ESLD patients, but studies limited by low participant numbers and confounding. Myostatin inhibition shown to improve sarcopenia in elderly, frail patients; further study needed in ESLD patients. Correction of low testosterone improves sarcopenia in male ESLD patients. Recent literature supports sarcopenia as an independent risk factor for poor outcomes in ESLD patients. Ongoing study is limited by poor standardization of sarcopenia definition and relevant muscle-mass cutoffs. Supervised exercise programs should be encouraged for all ESLD patients. More advanced therapies require further clinical investigation before their widespread use.