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World J Gastroenterol. Oct 28, 2022; 28(40): 5807-5817
Published online Oct 28, 2022. doi: 10.3748/wjg.v28.i40.5807
Improving the prognosis before and after liver transplantation: Is muscle a game changer?
Alexis Goffaux, Alicia Delorme, Géraldine Dahlqvist, Nicolas Lanthier
Alexis Goffaux, Nicolas Lanthier, Laboratory of Hepato-Gastroenterology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels 1200, Belgium
Alexis Goffaux, Alicia Delorme, Géraldine Dahlqvist, Nicolas Lanthier, Service d’Hépato-Gastroentérologie, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels 1200, Belgium
Author contributions: Goffaux A, Delorme A, Dahlqvist G and Lanthier N participated in the writing of this manuscript (literature review, first versions and corrections); and all authors have read and approve the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nicolas Lanthier, MD, PhD, Doctor, Professor, Laboratory of Hepato-Gastroenterology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Mounier, 52, Brussels 1200, Belgium. nicolas.lanthier@saintluc.uclouvain.be
Received: July 8, 2022
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
Processing time: 112 Days and 1.3 Hours
Abstract

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.

Keywords: Muscle; Liver; Transplantation; Sarcopenia; Myosteatosis; Frailty

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.