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Should Sarcopenia Increase Priority for Transplant or Is It a Contraindication?
Guido Stirnimann1,2, Maryam Ebadi3, Puneeta Tandon3
1Division of Gastroenterology & Liver Unit, Zeidler Ledcor Centre, University of Alberta Hospital, 8540 112 Street NW, Edmonton, T6G 2X8, Canada. stirnima@ualberta.ca.
Current Gastroenterology Reports
|September 28, 2018
Summary
Sarcopenia, a condition of muscle loss, negatively impacts survival for liver transplant candidates. Prioritizing patients with sarcopenia and low MELD scores could reduce waitlist mortality.
Area of Science:
- Hepatology
- Transplantation Medicine
- Nutritional Science
Background:
- Sarcopenia is prevalent in cirrhosis patients awaiting liver transplantation.
- The pathophysiology involves complex gut-liver and liver-muscle axes.
- Current transplant prioritization tools do not include nutritional status or sarcopenia.
Purpose of the Study:
- To review evidence on sarcopenia's impact in liver transplant candidates.
- To assess if sarcopenia should influence transplant prioritization or contraindication.
Main Methods:
- Review of current scientific literature.
- Analysis of sarcopenia's prognostic value in pre- and post-transplant settings.
- Discussion of diagnostic methods (CT/MRI) and management (nutritional optimization).
Main Results:
- Sarcopenia is a negative predictor of survival for liver transplant candidates and recipients.
- Patients with sarcopenia and low Model for End-Stage Liver Disease (MELD) or MELD-Na scores may benefit from transplant prioritization.
- Prioritization could decrease waitlist time and mortality.
Conclusions:
- Sarcopenia significantly affects outcomes in liver transplant candidates.
- Consideration of sarcopenia in transplant allocation could improve survival rates.
- Further research is needed to integrate sarcopenia into transplant criteria.
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