Frailty and sarcopenia are increasingly recognized as critical determinants of outcomes in patients with end-stage liver disease. Monday’s Emerging Trends Symposium will provide practical strategies to slow the progression of frailty and sarcopenia, particularly as clinicians prepare their patients for eventual liver transplantation.
Sicker patients, with comorbidities including advancing age, diabetes, hypertension and obesity, may be living longer while they await a liver transplant, but quality of life is diminished.
“This is becoming such an increasingly important topic because our patients with cirrhosis, including those on the liver transplant list, are becoming sicker – from progressive liver disease, advancing age, or increasing medical co-morbidities such as diabetes, obesity, and hypertension,” said Program Co-Chair Jennifer C. Lai, MD, Assistant Professor of Medicine at University of California-San Francisco. “Current management strategies of patients with cirrhosis have largely focused on manifestations that are specific to the liver disease and portal hypertension – such as ascites, varices and hepatic encephalopathy – but little is known about how to measure or modify these ‘extra-hepatic’ manifestations of frailty and sarcopenia that greatly impact their daily experience and quality of life.”
Dr. Lai and her co-chair Christopher J. Sonnenday, MD, Associate Professor at the University of Michigan, have assembled a program designed to provide practical bedside tools to not only measure frailty and sarcopenia, but also to help clinicians mitigate frailty and sarcopenia through pre-habilitation programs that incorporate exercise and nutritional therapies.
“In this program, we will present practical ways to integrate the concepts of frailty and sarcopenia into clinical practice, and then address real-life strategies to mitigate frailty and sarcopenia in our patients,” said Dr. Lai, who will present “Frailty 101.” Aldo J. Montano-Loza, MD, PhD, Associate Professor in the Division of Gastroenterology at the University of Alberta, will present “Sarcopenia 101.”
The next three speakers will focus on practical strategies to address frailty and sarcopenia when seen in patients. Janet Madill, PhD, Professor in the Division of Food & Nutritional Sciences at Brescia University College, will address nutrition-based strategies to reverse frailty and sarcopenia; and Nancy Howes, MSc, a physical therapist who has worked with the Multi-Organ Transplant Program at the London Health Sciences Centre in Canada, will provide exercise interventions for liver transplant candidates and recipients.
Dr. Sonnenday will wrap up the program with a presentation on how to develop and maintain a pre-habilitation program for liver transplant candidates, followed by a panel discussion by all speakers.
“Dr. Sonnenday and I have been brainstorming with all of the speakers and moderators to focus on making it as bedside as possible,” said Dr. Lai. “Our focus will be on taking these concepts of frailty and sarcopenia and all of the studies out of the ivory tower and focusing on how we can get clinicians to start integrating the evidence into practice and to improve the experience and outcomes of our patients with cirrhosis.”
Dr. Lai said this clinically-focused program is appropriate for any provider who manages patients with end-stage liver disease and should provide them with the tools they need to immediately help their patients with cirrhosis.
“My goal is to provide the audience with the tools to measure and the strategies to mitigate frailty and sarcopenia in patients with end-stage liver disease. After this session, they should be able to implement these tools and strategies immediately with the first patient they see after The Liver Meeting® and recommend to their patients what to do to start targeting the frailty with hopes of slowing down progression, preventing further progression or even reversing it,” she said.