Research progress on perioperative sarcopenia in liver transplantation / 中华临床营养杂志

ABSTRACT

Liver transplantation is the ultimate treatment for end-stage liver diseases such as decompensated cirrhosis and severe hepatitis, but with the sarcopenia incidence of up to 43.4%. Sarcopenia can significantly increase postoperative complications, prolong hospital stay, shorten postoperative survival and seriously affect patient prognosis. At present, sarcopenia is mainly evaluated by calculating the skeletal muscle measurement at the level of third lumbar vertebra on preoperative abdominal computed tomography images. Existing studies have demonstrated that the protein synthesis rate is reduced due to insufficient nutrient intake and metabolic disorder in liver transplantation patients. The identified liver-muscle axis mediators (e.g., hyperammonemia, low growth hormone and testosterone, endotoxemia), potential mediators (e.g., fibroblast growth factor 21) and gut microbiota play an important role in liver transplantation related sarcopenia. This paper reviewed the latest progress on the studies of perioperative sarcopenia in liver transplantation. Combining clinical practice, it is believed that combined therapy of rational nutrition and hormone supplementation, individualized resistance training and liver-muscle axis mediator pathway blockade, together with enhancement of clinicians' recognition of sarcopenia, may ameliorate or even reverse sarcopenia, effectively reduce perioperative complications and improve long-term prognosis of patients.