Low skeletal muscle mass predicts complications after kidney transplant in men
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Older men with a skeletal mass index threshold below 42 cm2 per m2 experienced more hospitalizations with longer stays in the year following kidney transplantation than those who had a higher preoperative skeletal mass index.
In addition, men with low skeletal muscle mass (SMI) had increased risks for wound complications, graft loss and mortality; these associations were not found for women.
According to Pierre-Guillaume Deliège, MD, of the department of nephrology at the University Hospital of Reims in France, and colleagues, recent evidence points to a high prevalence of sarcopenia and protein-energy wasting in patients with any stage chronic kidney disease, with low muscle mass present in 64% of patients on hemodialysis who were older than 60 years.
SMI to predict outcomes after surgery
“Low skeletal muscle mass is also an effective marker of outcome in major surgery. A review summarizing evidence from several studies showed that muscle mass predicts not only wait-list mortality in cirrhotic patients but also the outcomes following liver transplantation, especially increased postoperative mortality and length of hospital stay,” the researchers wrote. “Furthermore, preoperative low muscle mass is linked to mortality after surgery for digestive cancer and bladder cancer. In patients with CKD, lower psoas muscle attenuation in [Hounsfield units] HU or lower lean muscle mass and lower volume of the lean paraspinous muscle, were independently associated with higher mortality among kidney waitlist candidates.
Therefore, the aim of this retrospective study was to evaluate the impact of muscle mass, assessed by CT scan, on the length of hospital stay and on adverse outcomes after kidney transplantation in an aging end-stage renal disease (ESRD) population.”
For the study, Deliège and colleagues included 122 patients aged 60 years or older who underwent kidney transplantation at the University Hospital of Reims between December 2004 and December 2018. Pretransplant clinical and laboratory data were recorded, with researchers also considering data related to the transplant itself (specifically, whether the donor was living or deceased, donor age, duration of cold ischemia, presence of warm ischemia, presence of donor-specific antibody, number of major incompatibilities and immunosuppressive therapy used).
The primary outcome of the study was the length of the hospital stay immediately after transplantation. Secondary outcomes included the total length of hospital stays and wound complications (eg, eventration and delayed healing) during the first year after kidney transplantation, as well as a combined endpoint of all-cause mortality and kidney graft failure at this time.
Outcomes at 1-year after transplant
For men, researchers observed a low SMI was associated with longer immediate post-transplantation hospitalization (mean stay was 20.5 days), longer total hospitalization during the first year, a higher rate of wound complications (OR= 12.1) and a higher rate of the combined endpoint of graft loss or death (OR = 3.4).
“In summary, low muscle mass or pre-sarcopenia is an important factor affecting the morbi-mortality of male CKD patients, particularly after kidney transplantation,” Deliège and colleagues concluded of the findings. “It is imperative not to neglect its existence and to search for it systematically in older men, with a view to better selecting candidates for kidney transplantation and stratifying risk among selected candidates.
SMI, which can easily be calculated by routine CT scan, is a reliable tool to measure muscle mass in kidney transplantation candidates and could help nephrologists recommend appropriate rehabilitation and nutritional management for candidates with pre-sarcopenia on the kidney transplant wait-list in order to improve posttransplant outcomes.”
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