Body composition and the skeletal muscle compartment in liver transplantation: Turning challenges into opportunities

Frailty, nutritional status, and body composition are increasingly under the spotlight of interest in various clinical scenarios including liver transplantation. To address the rapidly accumulating evidence in this field, recent European and North American practice guidelines have clearly underlined the clinical importance of nutritional status and body composition with adopting their assessment in patients with liver disease and in transplant candidates into their recommendations. While earlier reports, and therefore present guidelines, were focusing predominantly on quantitative alterations of the skeletal muscle mass (sarcopenia), recent studies have identified qualitative alterations such as intramuscular fat accumulation (myosteatosis) and sarcopenic obesity as emerging risk factors for poor clinical outcomes. In this review, the role of body composition in the context of liver transplantation will be discussed with a focus on the skeletal muscle compartment. A brief overview of current assessment modalities including their limitations, diagnostic challenges, prognostic significance, and pathophysiology are included. Possibilities to incorporate body composition parameters into clinical decision making are discussed. In addition, novel trends and remaining challenges in the therapeutic targeting of body composition and the skeletal muscle compartment are highlighted.

Automated summary

Frailty, nutritional status, and body composition are crucial factors in liver transplantation, with recent guidelines emphasizing their clinical importance. While previous focus was on quantitative changes in skeletal muscle mass, recent studies highlight qualitative alterations like myosteatosis and sarcopenic obesity as emerging risk factors for poor outcomes. The review discusses the role of body composition, particularly skeletal muscle, in liver transplantation, covering assessment modalities, diagnostic challenges, prognostic significance, and ways to incorporate body composition parameters into clinical decision making, as well as highlighting novel trends and challenges in therapeutic targeting of body composition and skeletal muscle compartment.