Sarcopenia in Liver Transplantation: an Update

Purpose of Review: Patients undergoing liver transplantation (LT) are at high risk of sarcopenia and associated physical frailty. This review summarises advances in our knowledge of the definition, assessment, clinical implications and management of sarcopenia in LT. Recent Findings: Sarcopenia is associated with increased mortality, morbidity, physical disability and poor quality of life both before and after LT. Assessment tools have evolved from solely relying on imaging (i.e. muscle area only) to reproducible measures of function and physical performance status (i.e. liver frailty index). The multi-faceted management of sarcopenia is heavily reliant on nutrition (protein > 1.5 g/kg/day) and exercise (combined aerobic and resistance) advice. Summary: There is an increased awareness of the clinical implications, assessment tools and management for patients with sarcopenia awaiting LT. Future studies need to investigate the role of specific nutritional supplements, pharmaco-/behavioural therapy and the long-term outcomes (e.g. survival) of reversing sarcopenia in this patient population.