The role of static and dynamic evaluation of sarcopenia in liver transplant candidates

Sarcopenia, characterized by the loss of skeletal muscle mass, strength, and function, is a prevalent and severe complication of liver cirrhosis, irrespective of its etiology. Despite its early onset in cirrhosis, the impact of sarcopenia on liver transplantation (LT) outcomes is often underestimated.

This study evaluates the role of both static and dynamic assessments of sarcopenia in LT recipients, focusing on cardiopulmonary performance and the likelihood of prolonged ICU stays.

We studied 54 LT recipients (median age: 53.5 years, 59% female patients) at a single center. The L3 skeletal muscle index (L3SMI) was measured using computed tomography (CT) scans, while exercise tolerance was evaluated with the 6-minute walk test (6MWT). Cardiac output (CO) was recorded in liters per minute.

The median Model for End-Stage Liver Disease (MELD) score was 14.4, with 37% of patients classified as Child-Pugh class C. Major LT indications included autoimmune liver diseases (46.3%) and alcohol-related liver disease (ALD; 31.5%). Sarcopenia was present in 60.4% of patients. No significant differences in L3SMI were found related to underlying liver disease, gender, body mass index (BMI), or ammonia levels. However, patients with ALD covered significantly shorter distances in the 6MWT (p = 0.02). Sarcopenic patients had significantly higher CO than non-sarcopenic patients (p < 0.01). Intensive care unit (ICU) stay ≥3 days was observed in 77.8% of recipients, with no clear risk factors identified.

Sarcopenia linked to end-stage liver disease (ESLD) correlates with cirrhotic cardiomyopathy, as evidenced by increased CO. Further studies are required to clarify the role of 6MWT and CO in post-LT risk stratification.