Physical frailty and sarcopenia in end-stage liver disease: Do they improve after liver transplantation?

Sarcopenia and frailty are common complications of end-stage liver disease. Sarcopenia, a progressive loss of muscle mass, strength, and function, is a key component of frailty, which is defined as an increased vulnerability to stressors due to a cumulative decline in physiologic reserve. Sarcopenia and frailty are separate but related concepts, and the presence of either portends poor prognosis. Liver transplantation (LT) is intuitively felt to be a cure as it leads to reversal of key drivers of both entities including malnutrition, hypogonadism, and systemic inflammation. There is a paucity of literature on the course and impact of both frailty and sarcopenia following LT. Available literature suggests a complex course without universal improvement in sarcopenia following LT. The ongoing presence of sarcopenia after LT is associated with poor outcomes. Intervention and management of risk factors are likely necessary to combat this entity. Frailty seems to improve following LT, but further research including long-term studies are needed in this area.