Improving the prognosis before and after liver transplantation: Is muscle a game changer?

Liver transplantation (LT) is currently the only curative treatment option for selected patients with end stage liver disease or hepatocellular carcinoma. Improving waiting list-mortality, post-transplant morbidity and mortality and refining the selection of the patients remain our current central objectives. In this field, different concepts dealing with nutrition and the muscle such as sarcopenia, malnutrition, frailty or myosteatosis have emerged as possible game changers. For more than a decade, many prospective studies have demonstrated that sarcopenia and frailty are major predictive factors of mortality in the waiting list but also after LT. Malnutrition is also a well-known risk factor for morbidity and mor-tality. Muscle composition is a newer concept giving insight on muscle quality which has also been shown to be linked to poorer outcomes. Each of these terms has a precise definition as well as pathophysiological mechanisms. The bi-directional liver-muscle axis makes sense in this situation. Defining the best, easy to use in clinical practice tools to assess muscle quality, quantity, and function in this specific population and developing quality prospective studies to identify interventional strategies that could improve these parameters as well as evaluate the effect on mortality are among the important challenges of today.

Automated summary

Liver transplantation is currently the only curative treatment for patients with end stage liver disease or hepatocellular carcinoma. There is a need to improve waiting list mortality, post-transplant morbidity and mortality, and the selection of patients. Concepts such as sarcopenia, malnutrition, frailty, and myosteatosis have emerged as important factors in predicting mortality in the waiting list and after transplantation. Muscle composition and quality are also linked to poorer outcomes. The challenge lies in defining effective tools to assess muscle quality, quantity, and function in this specific population and developing interventional strategies to improve these parameters and evaluate their impact on mortality.