Department of Urology, Meijibashi Hospital, Matsubara, Japan.
Department of Urology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Int J Urol. 2024 Oct;31(10):1128-1136. doi: 10.1111/iju.15539. Epub 2024 Jul 16.
Sarcopenia is known to bring about adverse outcomes in elderly populations and dialysis patients. However, whether it is a risk factor in kidney transplant recipients (KTRs) has not yet been established. In the present study, the association of sarcopenia with mortality was investigated in KTRs.
We conducted a single-center prospective cohort study and recruited KTRs who were more than 1-year posttransplant from August 2017 to January 2018. The participants were followed for 5 years, and the Kaplan-Meier method and Cox proportional hazards model were used to assess patient survival.
A total of 212 KTRs with a median age of 54 years and median transplant vintage of 79 months were enrolled in this study. Among them, 33 (16%) had sarcopenia according to the Asia Working Group for Sarcopenia 2019 at baseline. During the 5-year follow-up period, 20 (9.4%) died, 5 returned to dialysis after graft loss, and 4 were lost to follow-up. The 5-year overall survival rate was 90%. After 1:1 propensity score matching, a matched cohort with 60 KTRs was generated. The overall survival rate was significantly lower in the sarcopenia group compared to the non-sarcopenia group (p = 0.025, log-rank test). Furthermore, mortality risk was significantly higher in the sarcopenia group compared to the non-sarcopenia group (hazard ratio = 7.57, 95% confidence interval = 0.94-62).
Sarcopenia was a predictor of mortality in KTRs. KTRs with suboptimal muscle status who were at risk for poor survival could have a clinical benefit by interventions for sarcopenia.
肌少症已知会对老年人群和透析患者产生不良后果。然而，它是否是肾移植受者（KTR）的危险因素尚未确定。在本研究中，研究了肌少症与 KTR 死亡率之间的关系。
我们进行了一项单中心前瞻性队列研究，并招募了 2017 年 8 月至 2018 年 1 月移植后 1 年以上的 KTR。对参与者进行了 5 年的随访，使用 Kaplan-Meier 方法和 Cox 比例风险模型评估患者的生存情况。
本研究共纳入 212 名中位年龄 54 岁、中位移植年限 79 个月的 KTR。其中，33 名（16%）患者根据 2019 年亚洲肌少症工作组的标准在基线时患有肌少症。在 5 年的随访期间，20 名（9.4%）患者死亡，5 名患者因移植物丢失后返回透析，4 名患者失访。5 年总生存率为 90%。经过 1:1 倾向评分匹配后，生成了一个匹配的队列，其中包括 60 名 KTR。肌少症组的总生存率明显低于非肌少症组（p=0.025，log-rank 检验）。此外，肌少症组的死亡率明显高于非肌少症组（风险比=7.57，95%置信区间=0.94-62）。
肌少症是 KTR 死亡的预测因素。肌肉状态不佳且生存预后较差的 KTR 通过肌少症干预措施可能会获得临床获益。
