Impacto da sarcopenia na mortalidade pós transplante hepático de pacientes com cirrose hepática: uma revisão sistemática e metanálise

Abstract

Introduction: Patients with advanced-stage liver cirrhosis have greater physical disability and risk of death. Clinical complications justified, at least in part, by the presence of sarcopenia. Liver transplantation is one of the possibilities of intervention for these patients. Thus, it is possible to think that sarcopenia has an impact on the clinical evolution of these patients undergoing liver transplantation. Objective: To assess the impact of sarcopenia present in the pre-liver transplant period on posttransplant mortality at 3 and 12 months. Methodology: This review followed the PRISMA recommendations, being registered in PROSPERO (CRD42022341890). Searches were carried out in Medline/Pubmed, Bireme, Medline Ovid, Embase, Web of Science and Central Cochrane databases, with the keywords: “sarcopenia”, “muscle mass”, “liver cirrhosis” and “liver transplantation”. Inclusion criteria were prospective and retrospective cohort studies, consisting of patients with liver cirrhosis, aged 18 years or older, who underwent liver transplantation. It is necessary to compare patients with liver cirrhosis with and without sarcopenia in the pretransplant period and the follow-up of these patients in the post-transplant period. For the mortality outcome, measures of association reported by univariate and multivariate analyses, at 3 and 12 months of follow-up, were extracted. The respective hazard ratios and their 95% confidence intervals were extracted. Results: 1252 possibly eligible articles were found. After reading titles and abstracts, 55 papers were selected for full reading, with 10 studies meeting the eligibility criteria. Multivariate analysis of mortality and sarcopenia at 12 months post liver transplantation in 4 studies showed that sarcopenia was not associated with an increased risk of mortality (2.89 [0.86, 9.70]; I²= 85.47%; p=0.09). In the 12-month univariate analysis, 9 studies showed that sarcopenia increases the chance of posttransplant mortality (1.94 [1.15, 3.29]; I²= 78.19%; p=0.01). Univariate analysis evaluated 3 months after liver transplantation, 8 included studies showed that sarcopenia increases the chance of mortality (2.38 [1.02, 5.53; I²= 88.48%; p=0.04). Conclusion: Pre-transplant sarcopenia appears to increase the probability of death at the end of one year in patients with liver cirrhosis undergoing liver transplantation.