Impact of Sarcopenia on Simultaneous Pancreas and Kidney Transplantation Outcomes: A Retrospective Observational Cohort Study

Abstract

Background. Sarcopenia has been identified as a predictive variable for surgical outcomes. We hypothesized that sarcopenia could be a key measure to identify frail patients and potentially predict poorer outcomes among recipients of simultaneous pancreas and kidney (SPK) transplants. Methods. We estimated sarcopenia by measuring psoas muscle mass index (PMI). PMI was assessed on perioperative computed tomography (CT) scans of SPK recipients. Results. Of the 141 patients identified between 2010 and 2018, 107 had a CT scan available and were included in the study. The median follow-up was 4 years (range, 0.5–9.1 y). Twenty-three patients had a low PMI, and 84 patients had a normal PMI. Patient characteristics were similar between the 2 groups except for body mass index, which was significantly lower in low PMI group (P < 0.001). Patient and kidney graft survival were not statistically different between groups (P = 0.851 and P = 0.357, respectively). A multivariate Cox regression analysis showed that patients with a low PMI were 5 times more likely to lose their pancreas allograft (hazard ratios, 5.4; 95% confidence intervals, 1.4-20.8; P = 0.015). Three out of 6 patients lost their pancreas graft due to rejection in the low PMI group, compared with 1 out of 9 patients in the normal PMI group. Among low PMI patients who had a follow-up CT scan, 62.5% (5/8) of those with a functional pancreas graft either improved or resolved sarcopenia, whereas 75.0% (3/4) of those who lost their pancreas graft continued to lose muscle mass. Conclusion. Sarcopenia could represent one of the predictors of pancreas graft failure and should be evaluated and potentially optimized in SPK recipients.

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

“…Streja et al used low serum creatinine as a surrogate for low muscle mass in a large registry data analysis and concluded that low muscle mass tends to result in poorer graft survival [ 29 ]. Interestingly, in a study of a patient collective that had received simultaneous pancreas-kidney transplantation, significantly lower pancreas survival, but not kidney survival, was seen in sarcopenic patients [ 30 ]. In our work, we showed that, in addition to sarcopenia, donor age and use of organs from deceased donors were associated with poorer transplant function in the long term.…”

“…While there are only a few publications dealing with sarcopenia as a predictor of kidney graft outcome [5,16,19,20,30,31], a large number of studies published in the last years show an increased postoperative morbidity and mortality after visceral surgery and in oncologic patients [37][38][39][40][41][42][43]. A meta-analysis explored independent risk factors for [45].…”

Recipient age and outcomes following simultaneous pancreas‐kidney transplantation in the new millennium: Single‐center experience and review of the literature

“…Independent of recipient age, recent studies have focused on the impact of sarcopenia and functional status on outcomes following SPKT. [59][60][61] DM is believed to contribute directly to the pathophysiology of frailty by increasing the risk of sarcopenia. Patients with T1DM in particular are at greater risk for sarcopenia secondary to the catabolic effect of insulin deficiency and excess accumulation of intramyocellular lipids and advanced glycation end products.…”

Frailty in Pancreas Transplantation

“…In contrast, kidney graft survival, patient survival, surgical complications, hospital stay, delayed kidney graft function, infections, and readmissions were not influenced by PMI. 92 In contrast to the few studies in pancreas transplantation, there are multiple studies evaluating the effect of frailty on pretransplant and peritransplant outcomes among various other solid organ transplant recipients, mainly in kidney transplantation. It is estimated that approximately 20% of ESRD patients listed for a kidney transplant are frail.…”

“…96 However, the rate of acute rejections was not significantly different in patients with lower PMI compared with those with normal PMI in that study, nor were there differences in surgical complications, infections, or patient deaths, probably indicating the study was inadequately powered due to the small sample size and varied transplant types. 94 Recently, Meier et al 92 studied 107 SPK recipients who had computed tomography scans in the perioperative period and found that patients with a low PMI were 6 times more likely to lose their pancreas allograft. In contrast, kidney graft survival, patient survival, surgical complications, hospital stay, delayed kidney graft function, infections, and readmissions were not influenced by PMI.…”