Korean J Transplant.  2021 Oct;35(Supple 1):S18. 10.4285/ATW2021.OP-1270.

Low skeletal muscle mass is associated with mortality in kidney transplant recipients

• Lee J
• Kim HJ
• Kim BS
• Kim MS
• Kim SI
• Huh KH

• KMID: 2521190
• DOI: http://doi.org/10.4285/ATW2021.OP-1270

Abstract

Background
Muscle wasting in chronic kidney disease is associated with increased cardiovascular events, morbidity, and mortality. However, whether pre-transplant skeletal muscle mass affects kidney transplant outcomes remains undetermined.
Methods
To examine the impact of skeletal muscle mass on transplant outcomes, we analyzed 623 patients who underwent kidney transplantation between 2004 and 2019. We measured the cross-sectional area of total skeletal muscle at the third lumbar region from a pre-transplant computed tomography scan. Low muscle mass was defined as the sex-specific lowest quartile of the skeletal muscle index.
Results
During the follow-up period, 44 patients (7.1%) died and 54 patients (8.7%) experienced death-censored graft loss. The 1-year, 3-year, and 5-year overall graft survival rates were 92.9%, 87.4%, and 82.8% for the low muscle mass group and 96.6%, 93.8%, and 91.4% for the high muscle mass groups, respectively (P=0.003). A multivariable Cox regression analysis confirmed that low muscle mass was independently associated with all-cause mortality (hazard ratio [HR], 3.881; 95% confidence interval [CI], 1.613–9.336; P=0.002) and overall graft loss (HR, 2.329; 95% CI, 1.301–4.169; P=0.004). By contrast, death-censored graft survival rates were comparable between low and high muscle mass groups. Low muscle mass was also associated with an increased risk of hospital readmission within 1 year after transplant.
Conclusions
Pre-transplant low skeletal muscle mass is associated with increased risk mortality and hospital readmission after kidney transplantation.