Long Term Outcomes on Malnutrition, Sarcopenia and Physical Frailty After Liver Transplantation: Impact of Hepatic Encephalopathy

Background: The liver is the second most transplanted organ worldwide. Despite the high survival rate after liver transplant (LT), malnutrition, sarcopenia and frailty are still present 3 months after surgery. These post-LT complications are associated with adverse clinical outcomes and decreased quality of life. However, the presence of these long-term complications remains undocumented. Purpose: The primary objective is to determine the prevalence of malnutrition, sarcopenia, and frailty starting from 1 year after LT. The secondary objectives are to describe muscle function, quality of life and employment status in LT recipients and to compare patients with and without history of hepatic encephalopathy (HE). Methods: Cross-sectional observational study is conducted including 80 patients transplanted between 2019 and 2021 at the CHUM in Montreal, Canada. A single virtual meeting is performed with each patient during which nutritional risk (Canadian Nutrition Screening Tool), sarcopenia (SARC-F questionnaire), frailty (FRAIL questionnaire), muscle function (chair stand test), quality of life (SF-36) and employment status are assessed. Results: Sixty-five patients have completed the study (41 men and 24 women) with a mean age of 58.8 ± 10.1 years. We observed that 12.3% of patients were at risk of malnutrition, 20% at risk of sarcopenia whereas 46.2% and 18.5% were prefrail and frail, respectively. The prevalence of the risk of malnutrition, sarcopenia, and frailty remained unchanged up until 3 years after LT. Muscle function was impaired after LT (15.8 ± 5.5s vs. 12.6s in healthy people). Patients with history of HE has higher risk of sarcopenia and frailty after LT. Regarding quality of life, the score of physical heath (61.3% ± 21.7) was slightly below normal and remain unchanged up until 3 years after LT. Unemployment was noted in 69.2% of patients of which 40% were in early retirement for a liver disease-related cause. Conclusion: Up to 3 years after LT, patients are still at risk of malnutrition, sarcopenia, and frailty. The physical component score of their quality of life score is below the score of the general population. The results of this project may help identify appropriate interventions to help reduce or prevent complications in the long-term post-LT.