# Screening for Malnutrition, Sarcopenia, and Physical Frailty Beyond One Year after Liver Transplantation

## TL;DR

This study found that liver transplant patients remain at risk for malnutrition, sarcopenia, and frailty up to three years post-transplant, emphasizing the need for long-term care.

## Contribution

The study provides novel long-term follow-up data on malnutrition, sarcopenia, and frailty risks beyond one year after liver transplantation.

## Key findings

- Malnutrition, sarcopenia, and frailty risks remained stable up to three years post-transplant.
- Energy intake and muscle function were significant predictors of malnutrition and sarcopenia.
- Only a minority of patients returned to work within three years after liver transplantation.

## Abstract

Malnutrition, sarcopenia, and frailty negatively impact quality of life and increase mortality following liver transplantation (LT). However, long-term follow-up data remain limited. This study aimed primarily to assess the malnutrition risk at 1-, 2-, and 3-years post-LT. Secondary objectives included evaluating the sarcopenia and frailty risk, muscle function, physical activity, quality of life, and employment status at the same time points.

This cross-sectional study included LT recipients with a history of cirrhosis, transplanted between January 2019 and December 2021. Each participant completed a single virtual meeting during which nutritional risk, sarcopenia, frailty risk, muscle function, physical activity, quality of life, employment status, and dietary intakes were assessed.

Sixty-six LT recipients (63.6% male) were included: cohort A (1-year post-LT, n = 25), cohort B (2 years post-LT, n = 14), and cohort C (3 years post-LT, n = 27). The prevalence of malnutrition (12.0%, 14.3%, and 11.1%), sarcopenia (16.0%, 28.6%, and 18.5%), and frailty risks (12.0%, 28.6%, and 18.5%) in cohorts A, B, and C, respectively, remained stable over time (P = 0.957, 0.626, and 0.436). Energy intake was a significant predictor of both malnutrition and sarcopenia, with muscle function predicting the risk of sarcopenia and frailty post-LT. Muscle function was lowest in cohort B and inferior in age-matched adults in all cohorts. One-third of patients had low physical activity levels, with no significant change across cohorts (P = 0.096). Quality of life remained unchanged, except for lower emotional well-being and health change scores in cohort C compared to cohort A (P = 0.039 and P < 0.001, respectively). Only 28.0%, 42.9%, and 25.9% of participants in cohorts A, B, and C, respectively, returned to work.

Up to 3 years after LT, patients were still at risk of malnutrition, sarcopenia, and frailty. The results of this study highlight the need for targeted interventions to improve outcomes and support long-term quality of life post-LT.