Sarcopenia increases mortality risk in liver transplantation: a systematic review and meta-analysis - Panminerva Medica 2024 March;66(1):47-54 (original) (raw)

REVIEW

language: English

Sarcopenia increases mortality risk in liver transplantation: a systematic review and meta-analysis

Konstantinos PROKOPIDIS 1, 2, Marco AFFRONTI 3, Giuseppe D. TESTA 4, Andrea UNGAR 4, Emanuele CEREDA 5, Lee SMITH 6, Francesco PEGREFFI 7, Mario BARBAGALLO 8, Nicola VERONESE 8 ✉

1 Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; 2 Society of Meta-research and Biomedical Innovation, London, UK; 3 Unit of Internal Medicine, AOU Paolo Giaccone Polyclinic, Palermo, Italy; 4 Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Florence, Italy; 5 Unit of Clinical Nutrition and Dietetics, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy; 6 Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK; 7 Department for Life Quality Studies, University of Bologna, Bologna, Italy; 8 Unit of Geriatrics, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy

INTRODUCTION: Liver transplantation is an efficacious treatment option for those with liver cirrhosis. However, the prognostic role of sarcopenia in these patients is unknown. Given this background, we conducted a systematic review and meta-analysis of the impact of sarcopenia on mortality in patients listed, evaluated and undergoing liver transplantation.
EVIDENCE ACQUISITION: Several databases were searched from the inception to December 2022 for observational studies regarding sarcopenia in liver transplant and mortality. We calculated the risk of mortality in sarcopenia vs. no sarcopenia using the most adjusted estimate available and summarizing the data as risk ratios (RRs) with their 95% confidence intervals (CIs). A random-effect model was considered for all analyses.
EVIDENCE SYNTHESIS: Among 1135 studies initially considered, 33 articles were included for a total of 12,137 patients (mean age: 55.3 years; 39.4% females). Over a median of 2.6 years and after adjusting for a median of 3 covariates, sarcopenia increased the risk of mortality approximately 2-fold (RR: 2.01; 95% CI: 1.70-2.36). After accounting for publication bias, the re-calculated RR was 1.75 (95% CI: 1.49-2.06). The quality of the studies was generally low, as determined by the Newcastle Ottawa Scale.
CONCLUSIONS: Sarcopenia was significantly linked with an increased risk of mortality in patients listed, evaluated, and undergoing a liver transplantation, indicating the need of interventional studies in this special population with the main aim to reverse this potential reversible condition and decrease mortality risk.

KEY WORDS: Sarcopenia; Liver transplantation; Meta-analysis; Mortality