Laboratory of Hepato-Gastroenterology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels 1200, Belgium.
Service d'Hépato-Gastroentérologie, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels 1200, Belgium.
World J Gastroenterol. 2022 Oct 28;28(40):5807-5817. doi: 10.3748/wjg.v28.i40.5807.
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.
肝移植（LT）目前是终末期肝病或肝细胞癌患者的唯一治愈性治疗选择。降低等待名单死亡率、移植后发病率和死亡率，并完善患者选择仍然是我们目前的主要目标。在这一领域，涉及营养和肌肉的不同概念，如肌肉减少症、营养不良、虚弱或肌内脂肪增多症，已成为可能改变游戏规则的因素。十多年来，许多前瞻性研究表明，肌肉减少症和虚弱是等待名单上死亡率的主要预测因素，但也是 LT 后的死亡率的主要预测因素。营养不良也是发病率和死亡率的一个众所周知的危险因素。肌肉组成是一个较新的概念，它提供了关于肌肉质量的深入了解，也表明与较差的结果相关。这些术语中的每一个都有一个精确的定义以及病理生理机制。这种双向的肝-肌肉轴在这种情况下是有意义的。确定最佳的、易于在临床实践中使用的工具来评估该特定人群的肌肉质量、数量和功能，并开展前瞻性研究以确定改善这些参数的干预策略，以及评估对死亡率的影响，是当今的重要挑战之一。
