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Muscle wasting: a nutritional criterion to prioritize patients for liver transplantation.
Curr Opin Clin Nutr Metab Care 2014; 17(3):219-25CO

Abstract

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.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

24613858

Citation

Montano-Loza, Aldo J.. "Muscle Wasting: a Nutritional Criterion to Prioritize Patients for Liver Transplantation." Current Opinion in Clinical Nutrition and Metabolic Care, vol. 17, no. 3, 2014, pp. 219-25.
Montano-Loza AJ. Muscle wasting: a nutritional criterion to prioritize patients for liver transplantation. Curr Opin Clin Nutr Metab Care. 2014;17(3):219-25.
Montano-Loza, A. J. (2014). Muscle wasting: a nutritional criterion to prioritize patients for liver transplantation. Current Opinion in Clinical Nutrition and Metabolic Care, 17(3), pp. 219-25. doi:10.1097/MCO.0000000000000046.
Montano-Loza AJ. Muscle Wasting: a Nutritional Criterion to Prioritize Patients for Liver Transplantation. Curr Opin Clin Nutr Metab Care. 2014;17(3):219-25. PubMed PMID: 24613858.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Muscle wasting: a nutritional criterion to prioritize patients for liver transplantation. A1 - Montano-Loza,Aldo J, PY - 2014/3/12/entrez PY - 2014/3/13/pubmed PY - 2014/12/15/medline SP - 219 EP - 25 JF - Current opinion in clinical nutrition and metabolic care JO - Curr Opin Clin Nutr Metab Care VL - 17 IS - 3 N2 - 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. SN - 1473-6519 UR - https://www.unboundmedicine.com/medline/citation/24613858/Muscle_wasting:_a_nutritional_criterion_to_prioritize_patients_for_liver_transplantation_ L2 - http://dx.doi.org/10.1097/MCO.0000000000000046 DB - PRIME DP - Unbound Medicine ER -