How do you use objective frailty or sarcopenia measures to trigger transplant referral in patients with low MELD?

Frailty and sarcopenia in patients with end-stage liver disease increase pretransplant waitlist mortality and risks of extended stay and complications post-transplant. We all know that a low MELD may be influenced by several factors, and by including creatinine in its formula, sarcopenia may spuriously lower creatinine values in addition to other poor prognostic factors such as ascites and need for frequent paracentesis.

Therefore, a low MELD in patients with sarcopenia and high LFI may benefit from timely referral to a transplant center. These centers also may offer prehabilitation programs to help lower the LFI by simple exercise plans and recommendations on proper nutrition to help rebuild or maintain muscle mass.