Korean J Transplant.  2023 Nov;37(Suppl 1):S230. 10.4285/ATW2023.F-8174.

The impact of sarcopenic obesity on survival outcomes in kidney transplant recipients: a retrospective study

• An S
• Lee KW
• Park JB

• KMID: 2551850
• DOI: http://doi.org/10.4285/ATW2023.F-8174

Abstract

Background
Chronic kidney disease often results in sarcopenic obesity, a condition characterized by decreased skeletal muscle mass and increased body fat, influencing outcomes in kidney transplant recipients. Existing research in this area is limited and conflicting.
Methods
In our retrospective study, we analyzed 152 kidney transplant recipients (2015–2020) using pretransplant computed tomography scans taken within 3 months before the operation at the L3 vertebral level to quantify muscle and adipose tissue. We defined sarcopenia as the lowest tertile of sex-specific muscle mass and obesity as the upper half of adipose tissue mass. Recipients were categorized into: group 1 sarcopenic obesity (n=15), group 2 sarcopenic non-obesity (n=36), group 3 non-sarcopenic obesity (n=60), and group 4 non-sarcopenic non-obesity (n=41).
Results
Groups 1 and 2 (the sarcopenia groups, n=51) showed higher instances of graft failure, patient death, and infection-related admission compared to groups 3 and 4 (the non-sarcopenia groups, n=101), although these differences were not statistically significant (P=0.58, P=0.21, and P=0.28, respectively). Nevertheless, when factoring in obesity, the group 1 (n=15) demonstrated significantly poorer patient survival outcomes compared to the group 2 (n=36, P=0.008) and the group 4 (n=41, P=0.014). Within group 1, 3 out of 15 patients (20%) died due to infection, a rate significantly higher than in groups 2, 3, and 4, where infection-related deaths were 0%, 3.3%, and 0%, respectively. Sarcopenia (hazard ratio, 1.69; 95% confidence interval, 1.02–2.79) and age (hazard ratio, 1.03; 95% confidence interval, 1.008–1.05) were identified as significant predictors of infection-related admission on multivariable analyses.
Conclusions
Our study underscores the marked impact of sarcopenic obesity on posttransplant survival, emphasizing the importance of detailed pretransplant assessments. With sarcopenia as a key predictor of infection-related admission, exploring interventions such as exercise or nutritional optimization could be advantageous in future research.