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World J Hepatol. May 27, 2025; 17(5): 106182
Published online May 27, 2025. doi: 10.4254/wjh.v17.i5.106182
Sarcopenia and frailty: An in-depth analysis of the pathophysiology and effect on liver transplant candidates
Grigorios Christodoulidis, Kyriaki Tsagkidou, Dimitra Bartzi, Ioana A Prisacariu, Eirini S Agko, Konstantinos E Koumarelas, Dimitrios Zacharoulis
Grigorios Christodoulidis, Department of General Surgery, University Hospital of Larissa, Larissa 41110, Thessalia, Greece
Kyriaki Tsagkidou, Department of Gastroenterology, University Hospital of Larisa, Larisa 41100, Thessalia, Greece
Dimitra Bartzi, Department of Oncology, The 251 Airforce General Hospital, Athens 11525, Greece
Ioana A Prisacariu, Department of Rehabilitation, Luzerner Kantonsspital Wolhusen, Lucerne 6110, Luzern, Switzerland
Eirini S Agko, Department of Intensive Care Unit, Asklepios Paulinen Clinic Wiesbaden, Wiesbaden 65197, Germany
Konstantinos E Koumarelas, Department of General and Orthopaedic Surgery, Luzerner Kantonsspital Wolhusen, Lucerne 6110, Luzern, Switzerland
Dimitrios Zacharoulis, Department of General Surgery, University of Thessaly, Larisa 41110, Thessalia, Greece
Co-first authors: Grigorios Christodoulidis and Kyriaki Tsagkidou.
Author contributions: Christodoulidis G designed the overall concept and outline of the manuscript; Christodoulidis G and Tsagkidou K contributed equally to this article, they are the co-first authors of this manuscript; Christodoulidis G, Tsagkidou K, Bartzi D, Prisacariu IA, Agko ES, Koumarelas KE, and Zacharoulis D contributed to the discussion and design of the manuscript, writing, editing the manuscript, and review of literature; and all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Grigorios Christodoulidis, MD, PhD, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Thessalia, Greece. gregsurg@yahoo.gr
Received: February 18, 2025
Revised: April 9, 2025
Accepted: May 7, 2025
Published online: May 27, 2025
Processing time: 98 Days and 11.1 Hours
Abstract

Cirrhosis represents the end stage of chronic liver disease, significantly reducing life expectancy as it progresses from a compensated to a decompensated state, leading to serious complications. Recent improvements in medical treatment have created a shift in cirrhosis management. Various causes, including hepatitis viruses, alcohol consumption, and fatty liver disease, contribute to cirrhosis and are closely linked to liver cancer. The disease develops through hepatocyte necrosis and regeneration, resulting in fibrosis and sinusoidal capillarization, leading to portal hypertension and complications such as ascites, hepatic encephalopathy, and organ dysfunction. Cirrhosis also holds an increased risk of hepatocellular carcinoma. Diagnosing cirrhosis involves assessing fibrosis scores through blood tests and measuring liver stiffness through elastography. Liver transplantation is the definitive treatment for end-stage liver disease and acute liver failure.

Keywords: Sarcopenia; Liver transplant; Liver fibrosis; End-stage liver disease; Frailty; Cirrhosis; Chronic liver disease; Pathophysiology; Artificial intelligence; Muscle mass loss

Core Tip: Cirrhosis is a term used to describe a complex pathophysiological condition, which causes diffuse damage to the liver. These conditions lead to overall hepatocyte degeneration and necrosis, excessive fibrosis and the development of regenerative nodules as fibrous tissue encases surviving hepatocytes. The term sarcopenia, was initially introduced by Rosenberg in 1989, initially referred only to the loss of muscle mass, but later, the quality of muscle mass was also included. Frailty is a common condition in patients with cirrhosis, and it is associated with increased morbidity and mortality. Sarcopenia and frailty are distinct features that share common pathophysiologic mechanisms, both affecting the course of action in candidates in pre- and post-liver transplantation.