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Page 10 of 12 D’Arcangelo et al. Hepatoma Res 2021;7:4 I http://dx.doi.org/10.20517/2394-5079.2020.109
[19]
in the early post-transplantation period. In agreement with previous findings , these findings suggest that
patients with sarcopenia are particularly vulnerable to bacterial infections [19,37,38] and that specific antibiotic
prophylaxis may be considered in these patients during the early period post-transplantation.

Our study has some limitations. Firstly, due to the retrospective design, only association and not causation
could be determined. Furthermore, some important variables such as donor and graft characteristics,
surgery-related factors, causes of death, and specific data on food intake or nutritional intervention before
or after LT were lacking. Thus, our findings require validation by large prospective cohorts. Secondly,
the most common indication for LT in our cohort was HCV-related cirrhosis and most patients were
[39]
transplanted before the introduction of direct acting antivirals . Now that the widespread adoption
of interferon-free antiviral treatments has significantly changed the composition of the wait-list as well
as post-transplant outcomes in HCV recipients [40-42] , new studies looking at the effect of sarcopenia are
needed.

In conclusion, we show that sarcopenia is a common finding in patients with cirrhosis awaiting
transplantation, independent of sex, indication for LT, aetiology, and severity of underlying liver disease.
In those who undergo transplantation with decompensated cirrhosis, sarcopenia is associated with a
significantly reduced post-transplant survival.

The assessment of sarcopenia in liver transplant candidates as well as its proactive treatment may improve
the recipient’s outcome and should be considered in all patients with cirrhosis awaiting transplantation,
particularly those who are decompensated.

DECLARATIONS
Authors’ contributions
Research design, performance of the research, and writing of the manuscript: D’Arcangelo F, Zanetto A
Research design and collection of the data: Aliberti C, Shalaby S, Pellone M, Sciarrone SS, Becchetti C,
Ferrarese A, Gambato M, Russo FP, Germani G, Senzolo M, Vitale A, Cillo U
Research design, critical revision and final approval of the manuscript: Burra P

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
This was a single-center, retrospective, case-control study approved by the Padua University Hospital
Ethical Committee (#AOP/0564). The study was conducted in compliance with the Declaration of Helsinki
and a waiver for informed consent was obtained (retrospective chart review).

Consent for publication
Not applicable.

Copyright
© The Author(s) 2021.