Copyright ©The Author(s) 2022.
World J Gastroenterol. Oct 28, 2022; 28(40): 5807-5817
Published online Oct 28, 2022. doi: 10.3748/wjg.v28.i40.5807
Table 1 Main studies investigating the deleterious role of frailty, low muscle mass, sarcopenia and myosteatosis in patients undergoing pre-transplant assessment
Patient selection
Patients, n
Sarcopenia, myosteatosis
Frailty parameters
Lai et al[15], 2019Ambulatory cirrhotic patients awaiting LT1014Non applicableLFIWaiting list mortalityFrailty: 25%. HR = 1.82; 95%CI: 1.31-2.52; P < 0.001
Fozouni et al[48], 2020LT recipients241Non applicableLFIAcute cellular rejection within 3 mo post-LTFrailty: 19%. OR = 3.3; 95%CI: 1.2-9.3; P = 0.02
Lai et al[47], 2022LT recipients1166Non applicableLFILT LOS. ICU stay. Inpatient days within 3 mo post-LT. Overall survival (1-3 and 5-yr mortality)Frailty: 21%. Prolonged LT LOS: OR = 2.00; 95%CI: 1.47-2.73. ICU stay: OR = 1.56; 95%CI: 1.12-2.14. Inpatient days within 3 mo. post-LT: OR = 1.72; 95%CI: 1.25-2.37. Overall survival: P = 0.02
Bhanji et al[41], 2018Cirrhotic patients assessed for LT675L3-MA (HU). L3-SMINon applicableHE. MortalitySarcopenia: 36%. HE: OR = 2.42; 95%CI: 1.43-4.10; P = 0.001. Mortality: Univariate HR = 2.02; 95%CI: 1.57-2.58; P < 0.001. Multivariate: HR = 2.15; 95%CI: 1.52-3.05; P < 0.001. Myosteatosis: 52%. HE: OR = 2.25; 95%CI: 1.32-3.85; P = 0.003. Mortality: Univariate: HR = 1.45; P = 0.004; 95%CI: 1.16-2.91. Multivariate: P = 0.69
Van Vugt et al[42], 2016LT candidates/recipients3804. Meta-analysisSMI. Total psoas areaNon applicableWaiting list mortality. Post-LT mortalityWaiting list mortality: HR = 1.72; 95%CI: 0.99-3.00; P = 0.02. Post-LT mortality: HR = 1.84; 95%CI: 1.11-3.05; P = 0.05
Bot et al[40], 2021ESLD patients awaiting LT262L3-SMI (cm2/m2). L3-MA (HU)Non applicableWaiting list mortalityLow SMI: HR = 2.580; 95%CI: 1.055-6.308. MA: HR = 9.124; 95%CI: 2.871-28.970
Czigany et al[24], 2020LT recipients225L3-SMI. L3-MA (HU)Non applicableMajor morbidity. ICU stay. LT LOSSarcopenia: 37%. Myosteatosis: 44%. Major morbidity: OR = 2.772; 95%CI: 1.516-5.066; P = 0.001. ICU stay: 18 ± 25 vs 11 ± 21 d, P < 0.001. LT LOS: 56 ± 55 vs 33 ± 24 d, P < 0.001
Table 2 Set of techniques to evaluate the physical activity as well as the quantity and quality of muscle
Physical activity assessment
IPAQReflects physical activity over the last 7 dEasier to implement. Understandable for the patient. Representative over 7 dSubjective. Poor estimation by the patient
PedometerMeasures walking activityInexpensive and easy to set up. Represents the physical activity of walkingReliability decreases with walking speed. Could induce changes in patient’s habits. Does not measure other physical activities
AccelerometerMeasures walking activityTakes slope and weight carried in considerationLong to wear for good representation. Not sensitive to the inclination of the walk or the load worn during the walk. Could induce changes in patient’s habits
Anthropometric measurement
BCGives information on arm circumference and stage of muscle mass depletionVery easy to perform (requires only a tape measure)User dependent
MAMC (BC-TSF)Gives information on arm muscle volumeWell described and easy to perform. Assesses muscle volume better than BC aloneUser dependent. Requires a caliper
BIAAllows to assess the body compositionSimple. Non-invasive. ReproductibleRequires specific equipment. Varies with fluid retention (common in cirrhosis)
Function tests
HandgripAllows to measure the strength of the forearm and wrist musclesLow cost. Easy to perform. Gold standardNot representative of total body strength
6MWTMeasures distance walked for 6 minEasy to perform. Reflects endurance and general fitnessCaution in patients with cardiac and respiratory problems
LFIMeasures frailty of patients calculated with a scoreEasy to perform. Little trainingNot assessable in severe encephalopathy
IsokineticMeasures the function and strength of a of group musclesGold standard. ReproducibleCost. Requires training and collaboration. Caution in patients with cardiac and respiratory problems
Leg pressMeasures the strength of the lower limbsSimple deviceRequires collaboration. Rougher assessment. Not well evaluated/used
Imaging techniques
USAllows to measure the echogenicity of the muscleNon-invasive. Not expensiveUser dependent. Variability with fat thickness, position of the probe. Requires training
CT-scanAllows to measure the surface of the muscle (easily) as well as its densityClear image. ReproduceableRadiation exposition
MRICan be used to evaluate the muscle surface. Measures the amount of fat within the muscle (PDFF)Clear image. ReproduceableCost. Time consuming. Contra-indications (claustrophobia, pacemaker, etc)
DXAAllows to measure the body composition (muscle, fat, water, etc)Clear image. ReproduceableRadiation exposition. Varies with fluid retention (common in cirrhosis)