Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Hepatology Reports
Published in: Current Hepatology Reports 2/2020

Open Access 01-06-2020 | Liver Transplantation | Management of Cirrhotic Patient (A Cardenas and P Tandon, Section Editors)

Sarcopenia in Liver Transplantation: an Update

Authors: A. Dhaliwal, F. R. Williams, O. El-sherif, Matthew J. Armstrong

Published in: Current Hepatology Reports | Issue 2/2020

Login to get access

Abstract

Purpose of Review

Patients undergoing liver transplantation (LT) are at high risk of sarcopenia and associated physical frailty. This review summarises advances in our knowledge of the definition, assessment, clinical implications and management of sarcopenia in LT.

Recent Findings

Sarcopenia is associated with increased mortality, morbidity, physical disability and poor quality of life both before and after LT. Assessment tools have evolved from solely relying on imaging (i.e. muscle area only) to reproducible measures of function and physical performance status (i.e. liver frailty index). The multi-faceted management of sarcopenia is heavily reliant on nutrition (protein > 1.5 g/kg/day) and exercise (combined aerobic and resistance) advice.

Summary

There is an increased awareness of the clinical implications, assessment tools and management for patients with sarcopenia awaiting LT. Future studies need to investigate the role of specific nutritional supplements, pharmaco-/behavioural therapy and the long-term outcomes (e.g. survival) of reversing sarcopenia in this patient population.
Literature
1.
Tandon P, Low G, Mourtzakis M, Zenith L, Myers RP, Abraldes JG, et al. A model to identify sarcopenia in patients with cirrhosis. Clin Gastroenterol Hepatol. 2016;14(10):1473–80 e3.PubMedCrossRef
2.
Krell RW, Kaul DR, Martin AR, Englesbe MJ, Sonnenday CJ, Cai S, et al. Association between sarcopenia and the risk of serious infection among adults undergoing liver transplantation. Liver Transpl. 2013;19(12):1396–402.PubMedCrossRef
3.
Periyalwar P, Dasarathy S. Malnutrition in cirrhosis: contribution and consequences of sarcopenia on metabolic and clinical responses. Clin Liver Dis. 2012;16(1):95–131.PubMedPubMedCentralCrossRef
4.•
Dasarathy S, Merli M. Sarcopenia from mechanism to diagnosis and treatment in liver disease. J Hepatol. 2016;65(6):1232–44 Excellent overview of the pathogenesis and future therapeutic targets of sarcopenia. PubMedPubMedCentralCrossRef
5.•
Lai JC, Rahimi RS, Verna EC, Kappus MR, Dunn MA, McAdams-DeMarco M, et al. Frailty associated with waitlist mortality independent of ascites and hepatic encephalopathy in a multicenter study. Gastroenterology. 2019;156(6):1675–82 Multi-centre study highlighting the ability of the Liver Frailty Index to predict mortality, irrespective of the degree of liver decompensation. PubMedCrossRef
6.
Kalafateli M, Mantzoukis K, Choi Yau Y, Mohammad AO, Arora S, Rodrigues S, et al. Malnutrition and sarcopenia predict post-liver transplantation outcomes independently of the Model for End-stage Liver Disease score. J Cachexia Sarcopenia Muscle. 2017;8(1):113–21.PubMedCrossRef
7.
8.•
Sinclair M, Chapman B, Hoermann R, Angus PW, Testro A, Scodellaro T, et al. Handgrip strength adds more prognostic value to the model for end-stage liver disease score than imaging-based measures of muscle mass in men with cirrhosis. Liver Transpl. 2019;25(10):1480–7 Large multi-centre study highlighting that the addition of simple measure of hand grip strength to a liver disease severity model (MELD) aids with identifying patients with cirrhosis at great risk of death. PubMedCrossRef
9.
10.
Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(4):601.PubMedPubMedCentralCrossRef
11.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412–23.PubMedPubMedCentralCrossRef
12.••
Carey EJ, Lai JC, Sonnenday C, Tapper EB, Tandon P, Duarte-Rojo A, et al. A North American expert opinion statement on sarcopenia in liver transplantation. Hepatology. 2019;70(5):1816–29 Concise expert opinion on the key assessment tools and recommend managements strategies in patients withs sarcopenia awaiting liver transplantation. PubMedCrossRef
13.
Nam NH, Kaido T, Uemoto S. Assessment and significance of sarcopenia in liver transplantation. Clin Transpl. 2019;33(12).
14.
van Vugt JLA, Levolger S, de Bruin RWF, van Rosmalen J, Metselaar HJ, Ijzermans JNM. Systematic review and meta-analysis of the impact of computed tomography-assessed skeletal muscle mass on outcome in patients awaiting or undergoing liver transplantation. Am J Transplant. 2016;16(8):2277–92.PubMedCrossRef
15.
Hanai T, Shiraki M, Imai K, Suetsugu A, Takai K, Moriwaki H, et al. Reduced handgrip strength is predictive of poor survival among patients with liver cirrhosis: a sex-stratified analysis. Hepatol Res. 2019;49(12):1414–26.PubMedCrossRef
16.
Cruz RJ Jr, Dew MA, Myaskovsky L, Goodpaster B, Fox K, Fontes P, et al. Objective radiologic assessment of body composition in patients with end-stage liver disease: going beyond the BMI. Transplantation. 2013;95(4):617–22.PubMedPubMedCentralCrossRef
17.
Montano-Loza AJ, Carey E, Ebadi M, Wang C, Dasarathy S, Kappus MR, et al. Skeletal muscle index indicates mortality risk more accurately than psoas muscle index in patients with cirrhosis. From the FLEXIT consortium. J Hepatol. 2018;68:S698–S9.CrossRef
18.
Carey EJ, Lai JC, Wang CW, Dasarathy S, Lobach I, Montano-Loza AJ, et al. A multicenter study to define sarcopenia in patients with end-stage liver disease. Liver Transpl. 2017;23(5):625–33.PubMedPubMedCentralCrossRef
19.
Ebadi M, Wang CW, Lai JC, Dasarathy S, Kappus MR, Dunn MA, et al. Poor performance of psoas muscle index for identification of patients with higher waitlist mortality risk in cirrhosis. J Cachexia Sarcopenia Muscle. 2018;9(6):1053–62.PubMedPubMedCentralCrossRef
20.•
Kuo SZ, Ahmad M, Dunn MA, Montano-Loza AJ, Carey EJ, Lin S, et al. Sarcopenia predicts post-transplant mortality in acutely ill men undergoing urgent evaluation and liver transplantation. Transplantation. 2019;103(11):2312–7 4-centre study highlighting that Skeletal Muscle Index (defined cut-off) on CT imaging in patients upto 90 days before transplantation is predictive of post transplant mortality. PubMedCrossRefPubMedCentral
21.
Montano-Loza AJ, Duarte-Rojo A, Meza-Junco J, Baracos VE, Sawyer MB, Pang JXQ, et al. Inclusion of sarcopenia within MELD (MELD-Sarcopenia) and the prediction of mortality in patients with cirrhosis. Clin Transl Gastroenterol. 2015;6(7):e102 e.PubMedPubMedCentralCrossRef
22.
Giusto M, Lattanzi B, Albanese C, Galtieri A, Farcomeni A, Giannelli V, et al. Sarcopenia in liver cirrhosis: the role of computed tomography scan for the assessment of muscle mass compared with dual-energy X-ray absorptiometry and anthropometry. Eur J Gastroenterol Hepatol. 2015;27(3):328–34.PubMedCrossRef
23.
Hara N, Iwasa M, Sugimoto R, Mifuji-Moroka R, Yoshikawa K, Terasaka E, et al. Sarcopenia and sarcopenic obesity are prognostic factors for overall survival in patients with cirrhosis. Intern Med. 2016;55(8):863–70.PubMedCrossRef
24.
Morgan MY, Madden AM, Soulsby CT, Morris RW. Derivation and validation of a new global method for assessing nutritional status in patients with cirrhosis. Hepatology. 2006;44(4):823–35.PubMedCrossRef
25.
Alberino F, Gatta A, Amodio P, Merkel C, Di Pascoli L, Boffo G, et al. Nutrition and survival in patients with liver cirrhosis. Nutrition. 2001;17(6):445–50.PubMedCrossRef
26.
Doherty TJ. Invited review: Aging and sarcopenia. J Appl Physiol (1985). 2003;95(4):1717–27.CrossRef
27.
Ebadi M, Tandon P, Moctezuma-Velazquez C, Ghosh S, Baracos VE, Mazurak VC, et al. Low subcutaneous adiposity associates with higher mortality in female patients with cirrhosis. J Hepatol. 2018;69(3):608–16.PubMedCrossRef
28.•
Montano-Loza AJ, Angulo P, Meza-Junco J, Prado CM, Sawyer MB, Beaumont C, et al. Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis. J Cachexia Sarcopenia Muscle. 2016;7(2):126–35 Key study highlighting the importance of sarcopenic obesity and excess fat deposition in muscle in predicting the clinical outcomes of patients with cirrhosis. PubMedCrossRef
29.
Carias S, Castellanos AL, Vilchez V, Nair R, Dela Cruz AC, Watkins J, et al. Nonalcoholic steatohepatitis is strongly associated with sarcopenic obesity in patients with cirrhosis undergoing liver transplant evaluation. J Gastroenterol Hepatol. 2016;31(3):628–33.PubMedPubMedCentralCrossRef
30.
Kamo N, Kaido T, Hamaguchi Y, Okumura S, Kobayashi A, Shirai H, et al. Impact of sarcopenic obesity on outcomes in patients undergoing living donor liver transplantation. Clin Nutr. 2019;38(5):2202–9.PubMedCrossRef
31.••
EASL. Clinical practice guidelines on nutrition in chronic liver disease. J Hepatol. 2019;70(1):172–93 Extensive evidence-based guideline of nutritional assessment and optimisation in patients with compensated and decompensated cirrhosis. CrossRef
32.••
Plauth M, Bernal W, Dasarathy S, Merli M, Plank LD, Schutz T, et al. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr. 2019;38(2):485–521 Extensive evidence-based guideline of nutritional assessment and optimisation in patients with compensated and decompensated cirrhosis. PubMedPubMedCentralCrossRef
33.
Lauretani F, Russo CR, Bandinelli S, Bartali B, Cavazzini C, Di Iorio A, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol (1985). 2003;95(5):1851–60.CrossRef
34.
Kim B-J, Ahn SH, Lee SH, Hong S, Hamrick MW, Isales CM, et al. Lower hand grip strength in older adults with non-alcoholic fatty liver disease: a nationwide population-based study. Aging. 2019;11(13):4547–60.PubMedPubMedCentral
35.
Malinis MF, Chen S, Allore HG, Quagliarello VJ. Outcomes among older adult liver transplantation recipients in the model of end stage liver disease (MELD) era. Ann Transplant. 2014;19:478–87.PubMedCrossRef
36.•
Tapper EB, Finkelstein D, Mittleman MA, Piatkowski G, Lai M. Standard assessments of frailty are validated predictors of mortality in hospitalized patients with cirrhosis. Hepatology (Baltimore, Md). 2015;62(2):584–90 One of the first studies highlighting the utility of Frailty Indices in patients hopsitalised with advanced liver disease. CrossRef
37.
Samoylova ML, Covinsky KE, Haftek M, Kuo S, Roberts JP, Lai JC. Disability in patients with end-stage liver disease: results from the functional assessment in liver transplantation study. Liver Transpl. 2017;23(3):292–8.PubMedPubMedCentralCrossRef
38.
Lai JC, Feng S, Terrault NA, Lizaola B, Hayssen H, Covinsky K. Frailty predicts waitlist mortality in liver transplant candidates. Am J Transplant. 2014;14(8):1870–9.PubMedPubMedCentralCrossRef
39.
Faustini-Pereira JL, Homercher-Galant L, Garcia E, de Mello Brandão AB, Marroni CA. Exercise capacity of cirrhotic patients with hepatopulmonary syndrome. Ann Hepatol. 2015;14(3):361–8.PubMedCrossRef
40.
Yadav A, Chang Y-H, Carpenter S, Silva AC, Rakela J, Aqel BA, et al. Relationship between sarcopenia, six-minute walk distance and health-related quality of life in liver transplant candidates. Clin Transpl. 2015;29(2):134–41.CrossRef
41.
Dunn MA, Josbeno DA, Tevar AD, Rachakonda V, Ganesh SR, Schmotzer AR, et al. Frailty as tested by gait speed is an independent risk factor for cirrhosis complications that require hospitalization. Am J Gastroenterol. 2016;111(12):1768–75.PubMedCrossRef
42.
Ney M, Haykowsky MJ, Vandermeer B, Shah A, Ow M, Tandon P. Systematic review: pre- and post-operative prognostic value of cardiopulmonary exercise testing in liver transplant candidates. Aliment Pharmacol Ther. 2016;44(8):796–806.PubMedCrossRef
43.
Bernal W, Martin-Mateos R, Lipcsey M, Tallis C, Woodsford K, McPhail MJ, et al. Aerobic capacity during cardiopulmonary exercise testing and survival with and without liver transplantation for patients with chronic liver disease. Liver Transpl. 2014;20(1):54–62.PubMedCrossRef
44.
Tandon P, Tangri N, Thomas L, Zenith L, Shaikh T, Carbonneau M, et al. A rapid bedside screen to predict unplanned hospitalization and death in outpatients with cirrhosis: a prospective evaluation of the clinical frailty scale. Am J Gastroenterol. 2016;111(12):1759–67.PubMedCrossRef
45.
Levett DZH, Jack S, Swart M, Carlisle J, Wilson J, Snowden C, et al. Perioperative cardiopulmonary exercise testing (CPET): consensus clinical guidelines on indications, organization, conduct, and physiological interpretation. Br J Anaesth. 2018;120(3):484–500.PubMedCrossRef
46.•
Wijeysundera DN, Pearse RM, Shulman MA, Abbott TEF, Torres E, Ambosta A, et al. Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study. Lancet. 2018;391(10140):2631–40 Highlights the importance of simple, subjective questionnaires, such as the Duke Activity Status Index, in predicting outcomes post major surgery. Needs validating in liver transplantation. PubMedCrossRef
47.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.PubMedCrossRef
48.•
Williams FR, Berzigotti A, Lord JM, Lai JC, Armstrong MJ. Review article: impact of exercise on physical frailty in patients with chronic liver disease. Aliment Pharmacol Ther. 2019;50(9):988–1000 Extensive overview and critical appraisal of the utility of hopsital and home-based exercise programs in patients with chronic liver disease. PubMedCrossRef
49.••
Lai JC, Covinsky KE, Dodge JL, Boscardin WJ, Segev DL, Roberts JP, et al. Development of a novel frailty index to predict mortality in patients with end-stage liver disease. Hepatology. 2017;66(2):564–74 The development of the first reproducible liver-specific frailty index (hand grip strength, balance, chairs stands) in predicting mortality in patients with end-stage liver disease. Needs validating in non-US countries. PubMedCrossRef
50.
Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94.PubMedCrossRef
51.
52.
Sinclair M, Poltavskiy E, Dodge JL, Lai JC. Frailty is independently associated with increased hospitalisation days in patients on the liver transplant waitlist. World J Gastroenterol. 2017;23(5):899–905.PubMedPubMedCentralCrossRef
53.
54.
• Lai JC, Sonnenday CJ, Tapper EB, Duarte-Rojo A, Dunn MA, Bernal W, et al. Frailty in liver transplantation: an expert opinion statement from the American Society of Transplantation Liver and Intestinal Community of Practice. Am J Transplant. 2019;19(7):1896–906 Detailed expert opinion on the key assessment tools and recommend managements strategies in patients withs sarcopenia awaiting liver transplantation. PubMedPubMedCentral
55.
Norman K, Kirchner H, Lochs H, Pirlich M. Malnutrition affects quality of life in gastroenterology patients. World J Gastroenterol. 2006;12(21):3380–5.PubMedPubMedCentralCrossRef
56.
Alvares-da-Silva MR, Reverbel da Silveira T. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition. 2005;21(2):113–7.PubMedCrossRef
57.
Bhanji RA, Moctezuma-Velazquez C, Duarte-Rojo A, Ebadi M, Ghosh S, Rose C, et al. Myosteatosis and sarcopenia are associated with hepatic encephalopathy in patients with cirrhosis. Hepatol Int. 2018;12(4):377–86.PubMedCrossRef
58.
Montano-Loza AJ, Meza-Junco J, Baracos VE, Prado CMM, Ma M, Meeberg G, et al. Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation. Liver Transpl. 2014;20(6):640–8.PubMedCrossRef
59.
van Vugt JLA, Alferink LJM, Buettner S, Gaspersz MP, Bot D, Darwish Murad S, et al. A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: a competing risk analysis in a national cohort. J Hepatol. 2018;68(4):707–14.PubMedCrossRef
60.
DiMartini A, Cruz RJ Jr, Dew MA, Myaskovsky L, Goodpaster B, Fox K, et al. Muscle mass predicts outcomes following liver transplantation. Liver Transpl. 2013;19(11):1172–80.PubMedPubMedCentralCrossRef
61.
Kaido T, Ogawa K, Fujimoto Y, Ogura Y, Hata K, Ito T, et al. Impact of sarcopenia on survival in patients undergoing living donor liver transplantation. Am J Transplant. 2013;13(6):1549–56.PubMedCrossRef
62.
Duarte-Rojo A, Ruiz-Margáin A, Montaño-Loza AJ, Macías-Rodríguez RU, Ferrando A, Kim WR. Exercise and physical activity for patients with end-stage liver disease: improving functional status and sarcopenia while on the transplant waiting list. Liver Transpl. 2018;24(1):122–39.PubMedCrossRef
63.
Tandon P, Ismond KP, Riess K, Duarte-Rojo A, Al-Judaibi B, Dunn MA, et al. Exercise in cirrhosis: translating evidence and experience to practice. J Hepatol. 2018;69(5):1164–77.PubMedCrossRef
64.
Sgrò P, Sansone M, Sansone A, Sabatini S, Borrione P, Romanelli F, et al. Physical exercise, nutrition and hormones: three pillars to fight sarcopenia. Aging Male. 2019;22(2):75–88.PubMedCrossRef
65.
Kruger C, McNeely ML, Bailey RJ, Yavari M, Abraldes JG, Carbonneau M, et al. Home exercise training improves exercise capacity in cirrhosis patients: role of exercise adherence. Sci Rep. 2018;8(1):99.PubMedPubMedCentralCrossRef
66.
Tsien C, Garber A, Narayanan A, Shah SN, Barnes D, Eghtesad B, et al. Post-liver transplantation sarcopenia in cirrhosis: a prospective evaluation. J Gastroenterol Hepatol. 2014;29(6):1250–7.PubMedPubMedCentralCrossRef
67.
Tsien C, Shah SN, McCullough AJ, Dasarathy S. Reversal of sarcopenia predicts survival after a transjugular intrahepatic portosystemic stent. Eur J Gastroenterol Hepatol. 2013;25(1):85–93.PubMedCrossRef
68.
Jo Y, Linton JA, Choi J, Moon J, Kim J, Lee J, et al. Association between cigarette smoking and sarcopenia according to obesity in the middle-aged and elderly Korean population: the Korea National Health and nutrition examination survey (2008-2011). Korean J Fam Med. 2019;40(2):87–92.PubMedPubMedCentralCrossRef
69.
Rom O, Kaisari S, Aizenbud D, Reznick AZ. Sarcopenia and smoking: a possible cellular model of cigarette smoke effects on muscle protein breakdown. Ann N Y Acad Sci. 2012;1259:47–53.PubMedCrossRef
70.
Schakman O, Kalista S, Barbe C, Loumaye A, Thissen JP. Glucocorticoid-induced skeletal muscle atrophy. Int J Biochem Cell Biol. 2013;45(10):2163–72.CrossRefPubMed
71.
72.
73.
Palmese F, Bolondi I, Giannone FA, Zaccherini G, Tufoni M, Baldassarre M, et al. The analysis of food intake in patients with cirrhosis waiting for liver transplantation: a neglected step in the nutritional assessment. Nutrients. 2019;11(10):E2462.PubMedCrossRef
74.
Haldar D, Kern B, Hodson J, Armstrong MJ, Adam R, Berlakovich G, et al. Outcomes of liver transplantation for non-alcoholic steatohepatitis: a European Liver Transplant Registry study. J Hepatol. 2019;71(2):313–22.PubMedPubMedCentralCrossRef
75.
Cordoba J, Lopez-Hellin J, Planas M, Sabin P, Sanpedro F, Castro F, et al. Normal protein diet for episodic hepatic encephalopathy: results of a randomized study. J Hepatol. 2004;41(1):38–43.PubMedCrossRef
76.
Gluud LL, Dam G, Les I, Cordoba J, Marchesini G, Borre M, et al. Branched-chain amino acids for people with hepatic encephalopathy. Cochrane Database Syst Rev. 2015;9:CD001939.
77.
Lai JC, Tandon P. How I Approach It: Improving nutritional status in patients with cirrhosis. Am J Gastroenterol. 2018;113(11):1574–6.PubMedCrossRef
78.
Mathur S, Janaudis-Ferreira T, Wickerson L, Singer LG, Patcai J, Rozenberg D, et al. Meeting report: consensus recommendations for a research agenda in exercise in solid organ transplantation. Am J Transplant. 2014;14(10):2235–45.PubMedCrossRef
79.
Garcia-Pagan JC, Santos C, Barbera JA, Luca A, Roca J, Rodriguez-Roisin R, et al. Physical exercise increases portal pressure in patients with cirrhosis and portal hypertension. Gastroenterology. 1996;111(5):1300–6.PubMedCrossRef
80.•
Berzigotti A, Albillos A, Villanueva C, Genesca J, Ardevol A, Augustin S, et al. Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: The SportDiet study. Hepatology. 2017;65(4):1293–305 Key study (n=60) highlighting that exercise and weight loss are safe in patients with cirrhosis and portal hypertension. PubMedCrossRef
81.
Morkane CM, Kearney O, Bruce D, Melikian C, Martin DS. An outpatient hospital-based exercise training programme for patients with cirrhotic liver disease awaiting transplantation: a feasibility trial. Transplantation. 2020;104(1):97–103.PubMedCrossRef
82.
Roman E, Garcia-Galceran C, Torrades T, Herrera S, Marin A, Donate M, et al. Effects of an exercise programme on functional capacity, body composition and risk of falls in patients with cirrhosis: a randomized clinical trial. PLoS One. 2016;11(3):e0151652.PubMedPubMedCentralCrossRef
83.
Zenith L, Meena N, Ramadi A, Yavari M, Harvey A, Carbonneau M, et al. Eight weeks of exercise training increases aerobic capacity and muscle mass and reduces fatigue in patients with cirrhosis. Clin Gastroenterol Hepatol. 2014;12(11):1920–6 e2.PubMedCrossRef
84.
Williams FR, Vallance A, Faulkner T, Towey J, Kyte D, Durman S, et al. Home-based exercise therapy in patients awaiting liver transplantation: protocol for an observational feasibility trial. BMJ Open. 2018;8(1):e019298.PubMedPubMedCentral
85.
Nishida Y, Ide Y, Okada M, Otsuka T, Eguchi Y, Ozaki I, et al. Effects of home-based exercise and branched-chain amino acid supplementation on aerobic capacity and glycemic control in patients with cirrhosis. Hepatol Res. 2017;47(3):E193–200.PubMedCrossRef
86.
Krasnoff JB, Vintro AQ, Ascher NL, Bass NM, Paul SM, Dodd MJ, et al. A randomized trial of exercise and dietary counseling after liver transplantation. Am J Transplant. 2006;6(8):1896–905.PubMedCrossRef
87.•
Moya-Najera D, Moya-Herraiz A, Compte-Torrero L, Hervas D, Borreani S, Calatayud J, et al. Combined resistance and endurance training at a moderate-to-high intensity improves physical condition and quality of life in liver transplant patients. Liver Transpl. 2017;23(10):1273–81 Highlights the need for both aerobic and resistance exercise post transplantation and the significant impact they can have on quality of life. PubMedCrossRef
88.
Moya-Najera D, Moya-Herraiz A, Gargallo P, Calatayud J, Escrig-Sos J, Colado JC. Clinical relevance of a balance training program on liver transplant patientsA Randomized Controlled Trial. Transplantation. 2019;103(5):965–72.PubMedCrossRef
89.
Corey RL, Whitaker MD, Crowell MD, Keddis MT, Aqel B, Balan V, et al. Vitamin D deficiency, parathyroid hormone levels, and bone disease among patients with end-stage liver disease and normal serum creatinine awaiting liver transplantation. Clin Transpl. 2014;28(5):579–84.CrossRef
90.
Davuluri G, Krokowski D, Guan BJ, Kumar A, Thapaliya S, Singh D, et al. Metabolic adaptation of skeletal muscle to hyperammonemia drives the beneficial effects of l-leucine in cirrhosis. J Hepatol. 2016;65(5):929–37.PubMedPubMedCentralCrossRef
91.•
Sinclair M, Grossmann M, Hoermann R, Angus PW, Gow PJ. Testosterone therapy increases muscle mass in men with cirrhosis and low testosterone: a randomised controlled trial. J Hepatol. 2016;65(5):906–13 A potential key therapy for male patients with sarcopenia. PubMedCrossRef
92.
Ohara M, Ogawa K, Suda G, Kimura M, Maehara O, Shimazaki T, et al. L-Carnitine suppresses loss of skeletal muscle mass in patients with liver cirrhosis. Hepatol Commun. 2018;2(8):906–18.PubMedPubMedCentralCrossRef
93.
White TA, LeBrasseur NK. Myostatin and sarcopenia: opportunities and challenges - a mini-review. Gerontology. 2014;60(4):289–93.PubMedCrossRef
94.
Metadata
Title
Sarcopenia in Liver Transplantation: an Update
Authors
A. Dhaliwal
F. R. Williams
O. El-sherif
Matthew J. Armstrong
Publication date
01-06-2020
Publisher
Springer US
Published in
Current Hepatology Reports / Issue 2/2020
Electronic ISSN: 2195-9595
DOI
https://doi.org/10.1007/s11901-020-00515-z

Other articles of this Issue 2/2020

Current Hepatology Reports 2/2020 Go to the issue

Management of the Cirrhotic Patient (A Cardenas and P Tandon, Section Editors)

Therapeutic and Prophylactic Anticoagulation in Cirrhosis Patients

Autoimmune, Cholestatic, and Biliary Diseases (S Gordon and C Bowlus, Section Editors)

Mechanisms of Fibrosis in Primary Biliary Cholangitis

Autoimmune, Cholestatic, and Biliary Diseases (S Gordon and CL Bowlus, Section Editors)

Newer Approaches to the Management of Pruritus in Cholestatic Liver Disease

Autoimmune, Cholestatic, and Biliary Diseases (S Gordon and CL Bowlus, Section Editors)

The Role of Cholangioscopy in the Management of Primary Sclerosing Cholangitis

Nutrition in Patients with Chronic Liver Disease (E Tapper, Section Editor)

Do Nutritional Interventions Improve the Outcomes of Patients with Cirrhosis and Ascites: a Systematic Review of Randomized Trials

Autoimmune, Cholestatic, and Biliary Diseases (S Gordon and CL Bowlus, Section Editors)

PSC and Overlap Syndromes
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits