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Muscle wasting: a nutritional criterion to prioritize patients for liver transplantation

Montano-Loza, Aldo J.

Current Opinion in Clinical Nutrition & Metabolic Care: May 2014 - Volume 17 - Issue 3 - p 219–225
doi: 10.1097/MCO.0000000000000046
TRANSLATIONAL RESEARCH IN WASTING DISEASES: Edited by Vickie E. Baracos, Claude Pichard and Didier Attaix

Purpose of review Cirrhosis is the result of the progression of necroinflammatory liver diseases leading to fibrosis, portal hypertension, and a catabolic state, which might cause muscle wasting or sarcopenia. In this review, we analyze the methods for muscularity assessment, the incidence and clinical impact of muscle wasting, and potential novel therapeutic strategies in cirrhosis. Finally, we evaluate the value of muscle wasting inclusion to conventional systems for liver transplant prioritization.

Recent findings Muscle wasting is present in up to 45% of patients with cirrhosis and is associated with higher risk of sepsis-related death rather than liver failure mortality. Despite the fact that muscle wasting is not included in the scores for prognosis in cirrhotic patients, as in the case of Model for End-Stage Liver Disease (MELD) or Child-Pugh, its presence should alert clinicians to the same extent as other complications do, such as ascites, hepatic encephalopathy, or variceal bleeding. Two studies have shown increased mortality risk after liver transplantation in patients with muscle wasting, whereas one study did not. Modification of MELD to include muscle wasting is associated with a modest improvement in the prediction of mortality in patients with cirrhosis.

Summary Muscle wasting is a frequent complication in cirrhosis and contributes to increased risk of sepsis-related mortality. The impact on mortality of muscle wasting after liver transplantation is controversial and needs further study. The MELD-sarcopenia score is associated with improvement in mortality prediction; however, prior to the widespread use of this composite score, validation in larger cohorts of patients with cirrhosis is necessary.

Division of Gastroenterology and Liver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada

Correspondence to Aldo J. Montano-Loza, MD, MSc, PhD, Assistant Professor, Zeidler Ledcor Centre, 130 University Campus, University of Alberta, Edmonton, AB T6G 2X8, Canada. Tel: +1 780 248 1892; fax: +1 780 248 1895; e-mail:

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