Liver transplantation (LT) has grown monumentally in the last 40 years. Sarcopenia has emerged as an independent factor associated with increased mortality in patients with end stage liver disease. In this review we aim to shed light upon recent developments in assessment, clinical implications, management of sarcopenia in patients requiring a liver transplant. We also bring attention to the impact of COVID-19 pandemic on sarcopenia which ranges from the disease pathology to the unprecedented preventive measures taken during this time. Assessment tools to risk stratify and assess the degree of COVID related deconditioning in patients with end stage liver disease is an exigency. Management of sarcopenia requires a multifarious approach to address nutritional factors, exercise and pharmacotherapy. We may have to shift gears to focus on more rigorous rehabilitation and nutritional techniques during the times of pandemic. Future studies should evaluate whether recovery of sarcopenia with nutritional management in combination with an exercise program is sustainable and whether that improvement in muscle mass leads to an improvement in clinical outcomes. Data regarding long term and short-term effects of COVID 19 pandemic, to form assessment tools that aim to identify patients who can benefit from multimodal prehabilitation and rehabilitation, is required.
Liver transplantation during the times of COVID-19 – viruses, vaccines and beyond