Stirnimann Guido, Ebadi Maryam, Tandon Puneeta, Montano-Loza Aldo J
Division of Gastroenterology & Liver Unit, Zeidler Ledcor Centre, University of Alberta Hospital, 8540 112 Street NW, Edmonton, T6G 2X8, Canada.
Department of Visceral Surgery and Medicine, Inselspital Bern, Bern University Hospital and University of Bern, 3010, Bern, Switzerland.
Curr Gastroenterol Rep. 2018 Sep 26;20(11):50. doi: 10.1007/s11894-018-0656-3.
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.
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.
本综述旨在讨论目前关于肌肉减少症对等待肝移植的肝硬化患者影响的证据，并确定其存在是否应被视为加速移植的标准或移植的禁忌症。
肌肉减少症是等待名单上和肝移植后患者生存的负面预测因素。已对肠-肝轴和肝-肌肉轴进行探索，以了解肌肉减少症的复杂病理生理学。肌肉减少症在肝硬化患者中很常见。理想情况下，诊断基于横断面图像分析（CT或MRI），治疗包括优化热量和蛋白质摄入。迄今为止，肝移植的优先排序工具尚未包括营养或肌肉减少症参数。终末期肝病模型（MELD）或MELD-Na评分低且有肌肉减少症的患者将受益于移植优先排序，以减少等待名单上的时间，从而降低死亡率。
