A North American Expert Opinion Statement on Sarcopenia in Liver Transplantation.

Published online

Journal Article

Loss of muscle mass and function, or sarcopenia, is a common feature of cirrhosis and contributes significantly to morbidity and mortality in this population. Sarcopenia is a main indicator of adverse outcomes in this population, including poor quality of life, hepatic decompensation, mortality in patients with cirrhosis evaluated for LT, longer hospital and intensive care unit stay, higher incidence of infection following LT, and higher overall health care cost. While it is clear that muscle mass is an important predictor of LT outcomes, many questions remain, including the best modality for assessing muscle mass, the optimal cut-off values for sarcopenia, the ideal timing and frequency of muscle mass assessment, and how to best incorporate the concept of sarcopenia into clinical decision making. For that reason, we assembled a group of experts to form the North American Working Group on Sarcopenia in Liver Transplantation to use evidence from the medical literature to address these outstanding questions regarding sarcopenia in LT. We believe sarcopenia assessment should be considered in all patients with cirrhosis evaluated for liver transplantation. Skeletal muscle index (SMI) assessed by computed tomography constitutes the best studied technique for assessing sarcopenia in patients with cirrhosis. Cut-off values for sarcopenia, defined as SMI <50 cm2 /m2 in male and <39 cm2 /m2 in female patients constitute the validated definition for sarcopenia in patients with cirrhosis. The management of sarcopenia requires a multi-pronged approach including nutrition, exercise and additional pharmacological therapy as deemed necessary. Future studies should evaluate whether recovery of sarcopenia with nutritional management in combination with an exercise program is sustainable, and how improvement in muscle mass might be associated with improvement in clinical outcomes. This article is protected by copyright. All rights reserved.

Full Text

Duke Authors

Cited Authors

  • Carey, EJ; Lai, JC; Sonnenday, C; Tapper, EB; Tandon, P; Duarte-Rojo, A; Dunn, MA; Tsien, C; Kallwitz, ER; Ng, V; Dasarathy, S; Kappus, M; Bashir, MR; Montano-Loza, AJ

Published Date

  • June 20, 2019

Published In

PubMed ID

  • 31220351

Pubmed Central ID

  • 31220351

Electronic International Standard Serial Number (EISSN)

  • 1527-3350

Digital Object Identifier (DOI)

  • 10.1002/hep.30828


  • eng

Conference Location

  • United States