Korean J Transplant.  2022 Nov;36(Supple 1):S361. 10.4285/ATW2022.F-5016.

Association of pretransplant skeletal muscle mass with outcomes in kidney transplant recipients

• Kim HJ
• Hong N
• Kim HW
• Yang J
• Kim BS
• Huh KH
• Kim MS
• Lee J

• KMID: 2535243
• DOI: http://doi.org/10.4285/ATW2022.F-5016

Abstract

Background
Muscle wasting in chronic kidney disease is associated with increased cardiovascular events, morbidity, and mortality. However, whether pretransplantation skeletal muscle mass affects kidney transplantation outcomes has not been established.
Methods
We analyzed 623 patients who underwent kidney transplantation between 2004 and 2019. We measured the crosssectional area of total skeletal muscle at the third lumbar vertebra level on pretransplantation computed tomography scans. Skeletal muscle mass index was calculated by normalizing skeletal muscle area to the square of the patient's height. Low muscle mass was defined as a mass within the sex-specific lowest quartile of the skeletal muscle index.
Results
Of the 623 included patients, 468 were in the normal muscle mass group and 155 were in the low muscle mass group. During the follow-up, 45 patients (7.2%) died and 56 patients (9.0%) experienced death-censored graft loss. The 1-year, 3-year, and 5-year patient survival rates were 95.4%, 90.6%, and 88.4% for the low muscle mass group and 98.5%, 96.8%, and 95.6% for the normal muscle mass groups. Multivariable Cox regression analysis confirmed that pretransplantation low skeletal muscle mass was independently associated with all-cause mortality (adjusted hazard ratio, 2.32; 95% confidence interval, 1.23–4.38). Low skeletal muscle mass was also associated with an increased risk of hospital readmission within one year after transplantation. Death-censored graft survival rates were comparable between the low and normal muscle mass groups, whereas patients with low skeletal muscle mass had consistently higher glomerular filtration rate values after transplantation than those with normal skeletal muscle mass.
Conclusions
Pretransplantation low skeletal muscle mass is associated with an increased risk of mortality and hospital readmission after kidney transplantation. These results suggest that appropriate therapeutic interventions for pretransplantation low skeletal muscle mass may improve long-term outcomes in kidney transplant recipients.