Guido Stirnimann1,2, Maryam Ebadi3, Puneeta Tandon3, Aldo J Montano-Loza4. 1. Division of Gastroenterology & Liver Unit, Zeidler Ledcor Centre, University of Alberta Hospital, 8540 112 Street NW, Edmonton, T6G 2X8, Canada. stirnima@ualberta.ca. 2. Department of Visceral Surgery and Medicine, Inselspital Bern, Bern University Hospital and University of Bern, 3010, Bern, Switzerland. stirnima@ualberta.ca. 3. Division of Gastroenterology & Liver Unit, Zeidler Ledcor Centre, University of Alberta Hospital, 8540 112 Street NW, Edmonton, T6G 2X8, Canada. 4. Division of Gastroenterology & Liver Unit, Zeidler Ledcor Centre, University of Alberta Hospital, 8540 112 Street NW, Edmonton, T6G 2X8, Canada. montanol@ualberta.ca.
Abstract
PURPOSE OF REVIEW: The purpose of this review is to discuss the current evidence regarding the impact of sarcopenia on patients with cirrhosis awaiting liver transplantation and to determine if its presence should be considered a criterion for expedited transplantation or a contraindication for transplantation. RECENT FINDINGS: Sarcopenia is a negative predictor of survival in patients on a waiting list and after liver transplant. The gut-liver axis and the liver-muscle axis have been explored to understand the complex pathophysiology of sarcopenia. Sarcopenia is a frequent finding in patients with cirrhosis. The diagnosis is ideally based on cross-sectional image analysis (CT or MRI) and treatment consists of optimization of caloric and protein intake. To date, prioritizing tools for liver transplantation have not included nutrition or sarcopenia parameters. Patients with a low Model for End-Stage Liver Disease (MELD) or MELD-Na score and sarcopenia would benefit from prioritization for transplant in order to reduce time on waiting list and therefore mortality.
PURPOSE OF REVIEW: The purpose of this review is to discuss the current evidence regarding the impact of sarcopenia on patients with cirrhosis awaiting liver transplantation and to determine if its presence should be considered a criterion for expedited transplantation or a contraindication for transplantation. RECENT FINDINGS:Sarcopenia is a negative predictor of survival in patients on a waiting list and after liver transplant. The gut-liver axis and the liver-muscle axis have been explored to understand the complex pathophysiology of sarcopenia. Sarcopenia is a frequent finding in patients with cirrhosis. The diagnosis is ideally based on cross-sectional image analysis (CT or MRI) and treatment consists of optimization of caloric and protein intake. To date, prioritizing tools for liver transplantation have not included nutrition or sarcopenia parameters. Patients with a low Model for End-Stage Liver Disease (MELD) or MELD-Na score and sarcopenia would benefit from prioritization for transplant in order to reduce time on waiting list and therefore mortality.
Authors: Puneeta Tandon; Michael Ney; Ivana Irwin; Mang M Ma; Leah Gramlich; Vincent G Bain; Nina Esfandiari; Vickie Baracos; Aldo J Montano-Loza; Robert P Myers Journal: Liver Transpl Date: 2012-10 Impact factor: 5.799
Authors: M Plauth; E Cabré; O Riggio; M Assis-Camilo; M Pirlich; J Kondrup; P Ferenci; E Holm; S Vom Dahl; M J Müller; W Nolte Journal: Clin Nutr Date: 2006-05-16 Impact factor: 7.324
Authors: Aldo J Montano-Loza; Judith Meza-Junco; Carla M M Prado; Jessica R Lieffers; Vickie E Baracos; Vincent G Bain; Michael B Sawyer Journal: Clin Gastroenterol Hepatol Date: 2011-09-03 Impact factor: 11.382
Authors: Aldo J Montano-Loza; Andres Duarte-Rojo; Judith Meza-Junco; Vickie E Baracos; Michael B Sawyer; Jack X Q Pang; Crystal Beaumont; Nina Esfandiari; Robert P Myers Journal: Clin Transl Gastroenterol Date: 2015-07-16 Impact factor: 4.488
Authors: Daniel Gotthardt; Karl Heinz Weiss; Melanie Baumgärtner; Alexandra Zahn; Wolfgang Stremmel; Jan Schmidt; Thomas Bruckner; Peter Sauer Journal: BMC Gastroenterol Date: 2009-09-25 Impact factor: 3.067