Published online Feb 28, 2024. doi: 10.3748/wjg.v30.i8.956
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
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.
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.
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.
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.
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.
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.
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.