Presence of Sarcopenia before Kidney Transplantation Is Associated with Poor Outcomes

Abstract

<b><i>Introduction:</i></b> Kidney transplantation is the treatment of choice for patients with renal failure. It is crucial to select which patients may benefit from renal transplantation and which are at high risk for post-transplant complications. Sarcopenia is associated with poor outcome in various conditions, including in chronic kidney disease patients. The gold standard for measuring sarcopenia is computed tomography (CT) imaging to estimate muscle mass and quality since it is objective, reproducible, and reflects the overall health condition. The data regarding those measurements among kidney transplant recipients are limited, therefore we aimed to describe it in patients before kidney transplantation, assess the parameters associated with sarcopenia, and evaluate the clinical significance of those markers on outcomes following transplantation. <b><i>Methods:</i></b> We retrospectively analyzed 183 kidney transplant recipients who had a CT scan 90 days prior to transplant. Sarcopenia was assessed by measuring the cross-sectional area (CSA) and mean muscle density of the psoas muscle at the third and fourth lumbar vertebrae levels and paravertebral muscles at the 12th thoracic vertebra level. <b><i>Results:</i></b> There was a strong linear correlation between muscle size measured as CSA of the psoas muscle at the L3 and L4 vertebral body level and the CSA of the paravertebral muscles at the D12 vertebra level, and a moderate correlation to muscle density at those levels. Age was independently associated with risk of sarcopenia, defined as psoas CSA in the lowest tertile, with every year of age increasing the risk by 5%. CSA at the L3 level had a significant independent association with post kidney transplantation mortality, with an adjusted hazard ratio of 0.86 per cm<sup>2</sup>. There was a significantly longer hospitalization period postoperation in kidney recipients in the lower tertile of psoas CSA and density. <b><i>Conclusions:</i></b> Sarcopenia as measured by psoas CSA is associated with poor short- and long-term outcomes following kidney transplantation and should be included as part of the assessment of kidney transplantation candidates.

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

“…A preferred method when using CT or MRI scans is to estimate skeletal muscle mass and density [ 49 ]. The psoas muscle is very well suited to diagnosing sarcopenia, as it does not change in chronic illnesses but not in acute illnesses but in chronic ones [ 19 , 49 ]. We showed that the assessment of sarcopenia with the measurement and calculation of TPA and HUAC of the psoas muscle was simple, fast, easy, and valid when performed by non-radiology employees.…”

“…The increasing number of patients with ESRD is challenging in transplant settings, especially as sarcopenia and frailty were found to be associated with a higher risk of surgical complications [14], higher mortality [15,19], delayed graft function [5,16], and shorter graft and patient survival [5,17]. In this study, we analyzed the impact of pre-transplant sarcopenia on graft function, postoperative complication rates, and survival.…”

“…A study in simultaneous pancreas-kidney transplant patients reported a non-significant trend associating low psoas muscle thickness as a parameter for sarcopenia with pancreas graft survival [ 18 ]. Druckmann et al recently showed that the cross-sectional area of the psoas muscle is an independent factor for posttransplant mortality after KT [ 19 ]. In contrast, another study in kidney-only transplant, simultaneous liver-kidney transplant, or pancreas-kidney transplant patients showed that pre-transplant sarcopenia had no effect on posttransplant renal function or re-hospitalization rates [ 20 ].…”

Sarcopenia Is an Independent Risk Factor for Subsequent Osteoporotic Vertebral Fractures Following Percutaneous Cement Augmentation in Elderly Patients

“…Sarcopenia can also be estimated using measurement of paraspinal muscle cross sectional area (CSA) which closely correlates to the total body muscle mass [ 7 , 9 , 10 , 11 , 12 ]. Previous studies have used computed-tomography (CT) or magnetic resonance imaging (MRI) modalities to assess the total psoas CSA (tCSA) at the level of either the L3 or the L4 vertebra [ 13 , 14 ]. The psoas tCSA of patients can be normalized against the vertebral body area or body height.…”

“…Refs. [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. As such, the goal of this study was to investigate whether sarcopenia can be correlated to an increased risk of SOVFs following percutaneous vertebral augmentation.…”