Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.
Department of General Surgery, University of Alberta, Edmonton, Alberta, Canada.
Liver Transpl. 2019 Sep;25(9):1422-1438. doi: 10.1002/lt.25591. Epub 2019 Jul 24.
Malnutrition is a common complication in patients with end-stage liver disease (ESLD) awaiting liver transplantation (LT). Malnutrition and sarcopenia overlap in etiology and outcomes, with sarcopenia being defined as reduced skeletal muscle mass and muscle function. The purpose of this review was to identify the prevalence of sarcopenia with and without obesity in adults and children with ESLD and to assess the methodological considerations in sarcopenia diagnosis and the association of sarcopenia with pre- and post-LT outcomes. A total of 38 articles (35 adult and 3 pediatric articles) retrieved from PubMed or Web of Science databases were included. In adults, the prevalence rates of pre-LT sarcopenia, pre-LT sarcopenic obesity (SO), post-LT sarcopenia, and post-LT SO were 14%-78%, 2%-42%, 30%-100%, and 88%, respectively. Only 2 adult studies assessed muscle function in patients diagnosed with sarcopenia. The presence of pre-LT sarcopenia is associated with higher wait-list mortality, greater postoperative mortality, higher infection risk and postoperative complications, longer intensive care unit (ICU) stay, and ventilator dependency. The emerging pediatric data suggest that sarcopenia is prevalent in pre- and post-LT periods. In 1 pediatric study, sarcopenia was associated with poor growth, longer perioperative length of stay (total/ICU) and ventilator dependency, and increased rehospitalization in children after LT. In conclusion, there is a high prevalence of sarcopenia in adults and children with ESLD. Sarcopenia is associated with adverse clinical outcomes. The present review is limited by heterogeneity in the definition of sarcopenia and in the methodological approaches in assessing sarcopenia. Future studies are needed to standardize the sarcopenia diagnosis and muscle function assessment, particularly in the pediatric population, to enable early identification and treatment of sarcopenia in adults and children with ESLD.
营养不良是等待肝移植（LT）的终末期肝病（ESLD）患者的常见并发症。营养不良和肌肉减少症在病因和结果上有重叠，肌肉减少症定义为骨骼肌质量和肌肉功能减少。本综述的目的是确定 ESLD 成人和儿童中存在和不存在肥胖的肌肉减少症的患病率，并评估肌肉减少症诊断中的方法学考虑因素以及肌肉减少症与 LT 前和 LT 后结局的关联。从 PubMed 或 Web of Science 数据库中检索到 38 篇文章（35 篇成人文章和 3 篇儿科文章）。在成人中，LT 前肌肉减少症、LT 前肌肉减少性肥胖（SO）、LT 后肌肉减少症和 LT 后 SO 的患病率分别为 14%-78%、2%-42%、30%-100%和 88%。仅有 2 项成人研究评估了诊断为肌肉减少症患者的肌肉功能。LT 前肌肉减少症的存在与更高的等待名单死亡率、更高的术后死亡率、更高的感染风险和术后并发症、更长的重症监护病房（ICU）停留时间和呼吸机依赖相关。新兴的儿科数据表明，肌肉减少症在 LT 前和 LT 后期间均很普遍。在 1 项儿科研究中，肌肉减少症与生长不良、围手术期总住院时间（ICU）和呼吸机依赖时间延长以及 LT 后儿童再住院率增加相关。总之，ESLD 成人和儿童的肌肉减少症患病率较高。肌肉减少症与不良临床结局相关。本综述受到肌肉减少症定义和评估肌肉减少症的方法学方法的异质性的限制。需要进一步的研究来标准化肌肉减少症诊断和肌肉功能评估，特别是在儿科人群中，以便能够早期识别和治疗 ESLD 成人和儿童的肌肉减少症。
