Physical Frailty and Sarcopenia in Liver Transplantation: How Should They Be Assessed and Addressed?

Area of Science:

• Hepatology
• Geriatrics
• Transplantation Medicine

Background:

• Physical frailty and sarcopenia are linked to higher morbidity and mortality in advanced chronic liver disease patients awaiting liver transplantation (LT).
• These conditions negatively impact post-LT recovery, daily living independence, and return to employment.
• Rising metabolic risk factors and an aging population exacerbate the prevalence of frailty and complicate LT decision-making.

Purpose of the Study:

• To review and summarize existing clinical tools for assessing physical frailty and sarcopenia in LT candidates.
• To evaluate the ease of use, accessibility, and efficacy of these assessment tools.
• To highlight the benefits and challenges of implementing pre- and post-LT rehabilitation programs.

Main Methods:

• Overview of various assessment tools for nutritional status, sarcopenia, and physical frailty.
• Categorization of tools includes patient questionnaires, bedside tests, and specialist investigations.
• Focus on ease of use, accessibility, and efficacy in the LT clinical pathway.

Main Results:

• A range of tools exists, from simple questionnaires to complex investigations like CT scans and CPET.
• No universal consensus or continuity in tool application exists across LT centers.
• Early identification enables targeted nutritional and exercise interventions.

Conclusions:

• Early identification of physical frailty in LT candidates is crucial for effective prehabilitation.
• Nutritional support (1.2-2.0 g/kg protein) and individualized exercise programs are key interventions.
• Standardizing assessment tools and implementing rehabilitation programs are essential for optimizing LT outcomes.