Department of Microbiology, Immunology and Transplantation, Abdominal Transplantation, KU Leuven, Leuven, Belgium.
Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium.
Acta Gastroenterol Belg. 2023 Apr-Jun;86(2):323-334. doi: 10.51821/86.2.11412.
Sarcopenia occurs in 30-70% of patients with end-stage liver disease and is associated with inferior pre- and post-liver transplant outcomes such as prolonged intubation times, long intensive care and hospitalization times, heightened risk of post-transplant infection, reduced health-related quality of life, and increased rates of mortality. The pathogenesis of sarcopenia is multifactorial and involves biochemical disturbances such as hyperammonemia, low serum concentrations of branched-chain amino acids (BCAAs) and low serum levels of testosterone, as well as chronic inflammation, inadequate nutritional status, and physical inactivity. Prompt recognition and accurate assessment of sarcopenia are critical and require imaging, dynamometry, and physical performance testing for the assessment of its subcomponents: muscle mass, muscle strength, and muscle function, respectively. Liver transplantation mostly fails to reverse sarcopenia in sarcopenic patients. In fact, some patients develop de novo sarcopenia after undergoing liver transplantation. The recommended treatment of sarcopenia is multimodal and includes a combination of exercise therapy and complementary nutritional interventions. Additionally, new pharmacological agents (e.g. myostatin inhibitors, testosterone supplements, and ammonia-lowering therapy) are under investigation in preclinical studies. Here, we present a narrative review of the definition, assessment, and management of sarcopenia in patients with end-stage liver disease prior to and after liver transplantation.
肌肉减少症发生于 30%-70%的终末期肝病患者，与肝移植术前和术后较差的预后相关，如延长插管时间、延长重症监护和住院时间、增加移植后感染风险、降低健康相关生活质量和增加死亡率。肌肉减少症的发病机制是多因素的，涉及生化紊乱，如血氨升高、支链氨基酸（BCAA）血清浓度降低和睾酮血清水平降低，以及慢性炎症、营养状况不佳和身体活动不足。及时识别和准确评估肌肉减少症至关重要，需要影像学、测力和体能测试来评估其亚组分：肌肉质量、肌肉力量和肌肉功能。肝移植术大多无法逆转肌肉减少症患者的肌肉减少症。事实上，一些患者在接受肝移植后会出现新的肌肉减少症。肌肉减少症的推荐治疗方法是多模式的，包括运动疗法和补充营养干预的结合。此外，一些新的药物制剂（如肌肉生长抑制素抑制剂、睾酮补充剂和降低血氨治疗）正在临床前研究中进行研究。在这里，我们对终末期肝病患者肝移植术前和术后肌肉减少症的定义、评估和管理进行了叙述性综述。
