Sarcopenia and liver transplant: The relevance of too little muscle mass

Abstract

Loss of muscle mass and function is a common occurrence in both patients with decompensated cirrhosis and those undergoing liver transplantation. Sarcopenia is associated with morbidity and mortality before and after liver transplantation. The ability of skeletal muscle mass to recover after transplant is questionable, and long term adverse events associated with persistent sarcopenia have not been well studied. Limited data is available examining mechanisms by which decreased muscle mass might develop. It is not clear which interventions might reduce the prevalence of sarcopenia and associated health burdens. However, measures to either decrease portal hypertension or improve nutrition appear to have benefit. Research on sarcopenia in the liver transplant setting is hampered by differing methodology to quantify muscle mass and varied thresholds determining the presence of sarcopenia. One area highlighted in this review is the heterogeneity used when defining sarcopenia. The health consequences, clinical course and potential pathophysiologic mechanisms of sarcopenia in the setting of cirrhosis and liver transplantation are further discussed.

Keywords: Sarcopenia; Liver transplantation; Cirrhosis; Body composition

Core tip: The loss of skeletal muscle mass, termed sarcopenia, is common in the setting of cirrhosis and liver transplant. Before liver transplant, it has been associated with increased morbidity and mortality. The long term effect of sarcopenia upon morbidity and mortality after transplant has been less rigorously studied. Data linking sarcopenia to adverse outcomes such as diabetes in the non-transplant setting are of interest especially with the high prevalence of post transplant metabolic syndrome. Current research on sarcopenia is limited by heterogeneity in the method to measure muscle mass and varied definitions of sarcopenia.