Screening for Malnutrition, Sarcopenia, and Physical Frailty Beyond One Year after Liver Transplantation

Malnutrition, sarcopenia, and frailty negatively impact quality of life and increase mortality following liver transplantation (LT). However, long-term follow-up data remain limited. This study aimed primarily to assess the malnutrition risk at 1-, 2-, and 3-years post-LT. Secondary objectives included evaluating the sarcopenia and frailty risk, muscle function, physical activity, quality of life, and employment status at the same time points.

This cross-sectional study included LT recipients with a history of cirrhosis, transplanted between January 2019 and December 2021. Each participant completed a single virtual meeting during which nutritional risk, sarcopenia, frailty risk, muscle function, physical activity, quality of life, employment status, and dietary intakes were assessed.

Sixty-six LT recipients (63.6% male) were included: cohort A (1-year post-LT, n = 25), cohort B (2 years post-LT, n = 14), and cohort C (3 years post-LT, n = 27). The prevalence of malnutrition (12.0%, 14.3%, and 11.1%), sarcopenia (16.0%, 28.6%, and 18.5%), and frailty risks (12.0%, 28.6%, and 18.5%) in cohorts A, B, and C, respectively, remained stable over time (P = 0.957, 0.626, and 0.436). Energy intake was a significant predictor of both malnutrition and sarcopenia, with muscle function predicting the risk of sarcopenia and frailty post-LT. Muscle function was lowest in cohort B and inferior in age-matched adults in all cohorts. One-third of patients had low physical activity levels, with no significant change across cohorts (P = 0.096). Quality of life remained unchanged, except for lower emotional well-being and health change scores in cohort C compared to cohort A (P = 0.039 and P < 0.001, respectively). Only 28.0%, 42.9%, and 25.9% of participants in cohorts A, B, and C, respectively, returned to work.

Up to 3 years after LT, patients were still at risk of malnutrition, sarcopenia, and frailty. The results of this study highlight the need for targeted interventions to improve outcomes and support long-term quality of life post-LT.