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. 2023 Feb 24;408(1):103.
doi: 10.1007/s00423-023-02836-1.

Sarcopenia of kidney transplant recipients as a predictive marker for reduced graft function and graft survival after kidney transplantation

H Karakizlis  1 , N Trudel  2   3 , A Brose  4 , A Reinisch  5 , M Reichert  2 , A Hecker  2 , F Bender  2 , I Askevold  2 , L Rainer  1 , R Weimer  1 , G A Krombach  4 , W Padberg  2 , J Liese  6
Affiliations

Sarcopenia of kidney transplant recipients as a predictive marker for reduced graft function and graft survival after kidney transplantation

H Karakizlis et al. Langenbecks Arch Surg. .

Abstract

Purpose: The association between sarcopenia of kidney transplant recipients and outcome after kidney transplantation (KT) has not yet been fully understood and is still considered controversial. The aim of our study was to analyze the impact of pre-transplant sarcopenia on graft function, postoperative complication rates, and survival of the patients after renal transplantation.

Methods: In this retrospective single-center study, all patients who underwent KT (01/2013-12/2017) were included. Demographic data, rejection rates, delayed graft function, and graft and patient survival rates were analyzed. Sarcopenia was measured in computed tomography images by the sex-adjusted Hounsfield unit average calculation (HUAC).

Results: During the study period, 111 single KTs (38 women and 73 men) were performed. Living donor kidney transplants were performed in 48.6%. In total, 32.4% patients had sarcopenia. Sarcopenic patients were significantly older (59.6 years vs. 49.8 years; p < 0.001), had a higher body mass index (BMI = 27.6 kg/m2 vs. 25.0 kg/m2; p = 0.002), and were more likely to receive deceased donor kidneys (72.2% vs. 41.3%; p = 0.002). Interestingly, 3 years after KT, the creatinine serum levels were significantly higher (2.0 mg/dl vs. 1.5 mg/dl; p = 0.001), whereas eGFR (39.9 ml/min vs. 53.4 ml/min; p = 0.001) and graft survival were significantly lower (p = 0.004) in sarcopenic transplant recipients. Sarcopenic patients stayed in hospital significantly longer postoperatively than those who were non-sarcopenic.

Conclusions: At the time of kidney transplantation, sarcopenia was found to predict reduced long-term graft function and diminished graft survival after KT. The early identification of sarcopenic patients can not only enable an optimized selection of recipients, but also the initiation of pre-habilitation programs during the waiting period.

Keywords: Graft survival; HUAC; Kidney function; Kidney transplantation; Sarcopenia.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Long-term effects of sarcopenia on graft function. Kidney graft function was evaluated A using the serum creatinine levels and B on estimated glomerular filtration rates (eGFR) by the formula of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) at indicated time points after kidney transplantation. Patients with graft failure were excluded from this analysis. Significant p values are shown
Fig. 2
Fig. 2
Graft survival after kidney transplantation stratified by sarcopenia. Graft survival is shown by the Kaplan–Meier analysis at indicated time points after kidney transplantation for sarcopenic and non-sarcopenic patients
See this image and copyright information in PMC

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