Current management strategies for sarcopenia and frailty in cirrhosis: Missing link in transplant candidacy

Figure 4 Pathophysiological framework linking cirrhosis to frailty and sarcopenia. Multiple pathways, including cirrhosis-specific mechanisms (synthetic dysfunction, ascites, encephalopathy), systemic drivers (inflammation, metabolic dysregulation, endocrine abnormalities), malnutrition, reduced physical activity, and social or organizational barriers, converge to produce muscle dysfunction. This dysfunction manifests along a continuum of frailty and sarcopenia, ultimately leading to adverse outcomes such as decompensation, impaired quality of life, higher health care utilization, increased mortality, and poorer post-transplant prognosis.