Published online Oct 28, 2022. doi: 10.3748/wjg.v28.i40.5807
Peer-review started: July 8, 2022
First decision: August 19, 2022
Revised: August 30, 2022
Accepted: October 11, 2022
Article in press: October 11, 2022
Published online: October 28, 2022
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.
Core Tip: Patients suffering from end stage liver disease currently have liver transplantation as the only curative treatment. In order to improve the pre and post transplantation management of patients, muscle related concepts such as sarcopenia, myosteatosis, frailty and malnutrition could be important potential game changers. Considering a bidirectional axis between the muscle and the liver, it is therefore justified to characterize the condition of the muscles adequately and to identify interventional strategies that could improve both muscle parameters and patient survival.