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Should Sarcopenia Increase Priority for Transplant or Is It a Contraindication?

  • Liver (S Cotler and E Kallwitz, Section Editors)
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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.

Summary

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.

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Acknowledgements

For Fig. 1, details of images from the following sources have been used:

Bartholomeo Eustachi (d. 1574), Tabulae anatomicae, 1783, U.S. National Library; Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). https://doi.org/10.15347/wjm/2014.010. ISSN 2002-4436.

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Authors and Affiliations

  1. Division of Gastroenterology & Liver Unit, Zeidler Ledcor Centre, University of Alberta Hospital, 8540 112 Street NW, Edmonton, T6G 2X8, Canada

    Guido Stirnimann, Maryam Ebadi, Puneeta Tandon & Aldo J. Montano-Loza

  2. Department of Visceral Surgery and Medicine, Inselspital Bern, Bern University Hospital and University of Bern, 3010, Bern, Switzerland

    Guido Stirnimann

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  1. Guido Stirnimann
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Guido Stirnimann, Maryam Ebadi, Puneeta Tandon, and Aldo J. Montano-Loza declare no conflict of interest.

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Stirnimann, G., Ebadi, M., Tandon, P. et al. Should Sarcopenia Increase Priority for Transplant or Is It a Contraindication?. Curr Gastroenterol Rep 20, 50 (2018). https://doi.org/10.1007/s11894-018-0656-3

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