Seet Christopher, Clementoni Laura, Akhtar Mohammed Rashid, Chandak Pankaj, Saoud Mohammed, Elsaadany Amr, Yaqoob Muhammad Magdi, Mohamed Ismail Heyder, Khurram Muhammad Arslan
Department of Nephrology and Transplantation, The Royal London Hospital, Bart's Health NHS Trust, London E1 1FR, UK.
Department of Radiology, The Royal London Hospital, Bart's Health NHS Trust, London E1 1FR, UK.
Life (Basel). 2024 Aug 20;14(8):1036. doi: 10.3390/life14081036.
Body composition is associated with prognosis in many clinical settings, and patients undergoing kidney transplantation are often high risk with multiple comorbidities. We aimed to assess the effect of sarcopenia and body composition on transplant outcomes.
We performed a retrospective analysis of 274 kidney transplants with CT scans within 3 years of transplantation. The skeletal muscle index (SMI) at the L3 vertebrae was used to evaluate sarcopenia (SMI < 40.31 cm/m in males, <30.88 cm/m in females). Sarcopenia, body mass index (BMI), and the visceral-to-subcutaneous-fat ratio (VSR) were assessed separately. We also used a composite BMI/sarcopenia measurement in four patient groups: BMI < 25/Non-Sarcopenic, BMI < 25/Sarcopenic, BMI > 25/Non-Sarcopenic, and BMI > 25/Sarcopenic. The outcomes measured were eGFR (1 and 3 months; and 1, 3, and 5 years), delayed graft function (DGF), rejection, major adverse cardiovascular events (MACE), and post-operative complications.
Sarcopenia was associated with an increased 1-year risk of MACE (OR 3.41, = 0.036). BMI alone had no effect on function, DGF, MACE, or on other complications. High VSR was associated with a lower risk of DGF (OR 0.473, = 0.016). When sarcopenia and BMI were assessed together, the BMI > 25/sarcopenic patients had the poorest outcomes, with increased risk of MACE (OR 26.06, = 0.001); poorer eGFR at 1, 3, 12, and 36 months; ( < 0.05 at all timepoints), and poorer graft survival ( = 0.002).
Sarcopenia alone is associated with an increased risk of MACE. Overweight sarcopenic patients are additionally at increased risk of graft loss and have poorer graft function for up to three years.
在许多临床情况下，身体组成与预后相关，接受肾移植的患者往往因多种合并症而处于高风险状态。我们旨在评估肌肉减少症和身体组成对移植结果的影响。
我们对274例肾移植患者进行了回顾性分析，这些患者在移植后3年内进行了CT扫描。使用L3椎体的骨骼肌指数（SMI）来评估肌肉减少症（男性SMI<40.31cm/m，女性<30.88cm/m）。分别评估肌肉减少症、体重指数（BMI）和内脏与皮下脂肪比率（VSR）。我们还在四个患者组中使用了BMI/肌肉减少症综合测量：BMI<25/非肌肉减少症、BMI<25/肌肉减少症、BMI>25/非肌肉减少症和BMI>25/肌肉减少症。测量的结果包括估算肾小球滤过率（eGFR，1个月和3个月；以及1年、3年和5年）、移植肾功能延迟恢复（DGF）、排斥反应、主要不良心血管事件（MACE）和术后并发症。
肌肉减少症与MACE的1年风险增加相关（OR 3.41， = 0.036）。单独的BMI对功能、DGF、MACE或其他并发症没有影响。高VSR与较低的DGF风险相关（OR 0.473， = 0.016）。当同时评估肌肉减少症和BMI时，BMI>25/肌肉减少症的患者预后最差，MACE风险增加（OR 26.06， = 0.001）；在1个月、3个月、12个月和36个月时eGFR较差（所有时间点均<0.05），移植存活率较差（ = 0.002）。
单独的肌肉减少症与MACE风险增加相关。超重的肌肉减少症患者额外存在移植丢失风险增加，并且在长达三年的时间内移植功能较差。
