Management of Children Awaiting Liver Transplantation: Sarcopenia, Cholestasis and Beyond.

Sarcopenia has been increasingly recognized as a risk factor for worse outcomes in liver transplantation; however, the data remain limited on pediatric-specific outcomes. These gaps in knowledge are in part due to the lack of a standardized definition, challenges inherent to functional assessments in children, and overlapping features with other nutritional states. It is important to understand the differences between malnutrition, frailty, and sarcopenia to best apply nutritional assessments to our clinical practice and advance our understanding of how sarcopenia impacts patient outcomes. In the present review, we highlight areas of unmet need in identifying, evaluating, and treating sarcopenia in children with cholestatic liver disease peri-transplant. We review what is known and what remains unknown about the disease mechanism of sarcopenia in pediatric versus adult patients with chronic liver disease and identify future research priorities in the field.