Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2024; 30(8): 956-968
Published online Feb 28, 2024. doi: 10.3748/wjg.v30.i8.956
Prevalence and clinical impact of sarcopenia in liver transplant recipients: A meta-analysis
Min-Jie Jiang, Mu-Chen Wu, Zhong-Hui Duan, Jing Wu, Xiao-Tong Xu, Juan Li, Qing-Hua Meng
Min-Jie Jiang, Mu-Chen Wu, Jing Wu, Xiao-Tong Xu, Juan Li, Qing-Hua Meng, Department of Hepatology, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
Zhong-Hui Duan, Department of Emergency, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
Co-first authors: Min-Jie Jiang and Mu-Chen Wu.
Author contributions: Jiang MJ, Wu MC, and Meng QH conceived and designed the experiments; Jiang MJ, and Wu MC analyzed the data; Duan ZH, Wu J, Xu XT, and Li J collected the information; Jiang MJ and Wu MC wrote the paper; Meng QH reviewed and edited the paper; all authors contributed to preparing the manuscript and approved the contents. Jiang MJ and Wu MC contributed equally to this work as co-first authors. The reasons for designating Jiang MJ and Wu MC as co-first authors are twofold. First, the research was performed as a collaborative effort, and the designation of co-corresponding authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and management of post-submission matters, ultimately enhancing the paper's quality and reliability. Second, Jiang MJ and Wu MC contributed efforts of equal substance throughout the research process. The choice of these researchers as co-corresponding authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study. In summary, we believe that designating Jiang MJ and Wu MC as co-first authors of is fitting for our manuscript as it accurately reflects our team's collaborative spirit, equal contributions, and diversity.
Conflict-of-interest statement: All authors have no conflict of interest.
PRISMA 2009 Checklist statement: This meta-analysis was conducted based on the PRISMA checklist and was registered in PROSPERO (CRD42022379765).
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:
Corresponding author: Qing-Hua Meng, MD, PhD, Doctor, Professor, Department of Hepatology, Beijing You-An Hospital, Capital Medical University, No. 8 Xitoutiao, Youanmen Wai, Fengtai District, Beijing 100069, China.
Received: October 16, 2023
Peer-review started: October 16, 2023
First decision: December 21, 2023
Revised: January 3, 2024
Accepted: February 1, 2024
Article in press: February 1, 2024
Published online: February 28, 2024
Research background

Liver transplantation (LT) has become the standard treatment for patients with end-stage liver disease (ESLD). With the widespread shortage of human organs, rigorous selection of LT candidates is essential. Over the past few years, sarcopenia has become a topic of prolific exploration in patients with ESLD. Sarcopenia has recently been recognized as a new prognostic factor for predicting outcomes in LT candidates. Therefore, this study aimed to estimate the prevalence of sarcopenia and evaluate its clinical effect on LT candidates.

Research motivation

As a major component of malnutrition, sarcopenia is a strong predictor of morbidity and mortality in patients with ESLD. However, the link between sarcopenia and LT candidates is not well studied.

Research objectives

This meta-analysis aimed to systematically evaluate the literature about patients who underwent LT to summarize the diagnostic criteria for sarcopenia, estimate its prevalence, and assess its effect on clinical outcomes.

Research methods

This systematic search was conducted in PubMed, Web of Science, EMBASE, and Cochrane Library for original English-language articles that investigated the prevalence and influence of sarcopenia on patients undergoing LT from database inception to November 30, 2022. The prevalence of sarcopenia was determined through a meta-analysis. The effect of sarcopenia on the incidence of post-LT survival was evaluated using the pooled unadjusted hazard ratio (HR) or adjusted HR and 95% confidence intervals.

Research results

Twenty-five studies involving 7760 patients undergoing LT were included. The pooled prevalence of sarcopenia in patients undergoing LT was 40.7%. The 1-, 3-, and 5-year cumulative probabilities of post-LT survival in patients with preoperative sarcopenia were all lower than those without sarcopenia (P < 0.05). Sarcopenia was associated with an increased risk of post-LT mortality in patients undergoing LT. Patients with preoperative sarcopenia had a longer intensive care unit stay, a high risk ratio of sepsis, and serious post-LT complications than those without sarcopenia.

Research conclusions

Sarcopenia is prevalent in a substantial proportion of patients undergoing LT. This study also showed that sarcopenia was associated with a 1.58-fold higher risk of post-LT mortality. Sarcopenia was also associated with long-term survival rates and adverse post-LT outcomes.

Research perspectives

Because of the high prevalence and adverse post-LT outcomes, sarcopenia should be considered a part of the initial evaluation of LT candidates. More studies are needed to incorporate sarcopenia into a formal prognostic scale for LT recipients.