Impact of L-carnitine supplementation on post-transplant outcomes in liver transplant candidates with sarcopenia: A randomized controlled open-label trial.

BACKGROUND & AIMS: Sarcopenia, characterized by loss of skeletal muscle mass and strength, is a common complication of advanced liver disease and worsens post-transplant outcomes. While L-carnitine may improve muscle mass and function, its impact on sarcopenic liver transplant candidates remains unclear. We aimed to evaluate the impact of L-carnitine supplementation on clinical outcomes and mortality in sarcopenic patients following liver transplantation.

METHODS

This randomized, controlled study included 53 HCV-related cirrhotic patients awaiting liver transplantation, divided into three groups: sarcopenia with L-carnitine (n = 18), sarcopenia without L-carnitine (n = 18), and non-sarcopenia (n = 17). Clinical, anthropometric, muscle mass, and biochemical parameters (secondary outcomes) were evaluated before and 6 months after transplantation, along with post-transplant mortality (primary outcome).

RESULTS

Sarcopenic patients receiving L-carnitine showed significant post-transplant improvements in ascites, lower limb edema, anthropometric measures (TSF, MAC, handgrip), and biochemical markers (INR, albumin, bilirubin, platelets). Compared to patients without L-carnitine, the supplemented group achieved greater gains in muscle mass index (1 vs. 0 cm2/m2; P = 0.014), TSF (4 vs. -4 mm; P = 0.049), BMI (2 vs. -2 kg/m2; P = 0.026), and reductions in bilirubin (-15.2 vs. 20.5 mmol/L; P = 0.001). Mortality was significantly lower in the L-carnitine group (16.7 % vs. 55.6 %; P = 0.003), with survival rates comparable to non-sarcopenic patients.

CONCLUSION

L-carnitine supplementation in sarcopenic liver transplant candidates significantly improved post-transplant outcomes, muscle mass, and survival with mortality rates comparable to non-sarcopenic patients. These findings suggest a potential role of L-carnitine in optimizing pre-transplant care and enhancing post-transplant outcomes in this high-risk population.