The Impact of Sarcopenia, Myosteatosis, and Malnutrition on Renal Function of Kidney Transplant Recipients

Abstract

Background: Patients with end-stage renal disease eligible for kidney transplant face multiple comorbidities and often are affected by malnutrition, sarcopenia, and myosteatosis. The role of the latter on post-transplantation renal function remains controversial; therefore, this study was conducted to evaluate the influence of sarcopenia, malnutrition, and myosteatosis on delayed graft function (DGF) and renal function of renal transplant recipients (RTR).

Methods: This was a monocentric retrospective study of RTR with preoperative computed tomography (CT) scans undergoing kidney transplantation between January 2014 and December 2022. Participants were stratified into matched cohorts based on sarcopenia (skeletal muscle index), malnutrition (CONUT score), and myosteatosis (IMAT) status. The primary outcome was delayed graft function (DGF), while secondary outcomes included creatinine level, azotemia level, and estimated glomerular filtration rate for each matched cohort at 3 and 6 months and 1, 2, 3, and 5 years. A multivariate analysis was performed as well.

Results: Eighty-six patients were included. No differences in DGF between malnourished and nonmalnourished patients, between sarcopenic and nonsarcopenic patients, or between IMAT groups were observed. Malnutrition was correlated with higher long-term azotemia, creatinine, and eGFR levels, while sarcopenia was associated with higher short-term creatinine and azotemia levels. Multivariate analysis revealed significant interactions among IMAT, CONUT score, and eGFR at 6 months.

Conclusion: There are slight differences in DGF prevalence between sarcopenic and nonsarcopenic patients and between malnourished and nonmalnourished patients. More studies with larger cohorts are needed to validate the link between post-transplantation kidney graft, renal function, and preoperative metabolic status.