Pre- and Post-Kidney Transplant Abdominal Computed Tomography-Based Muscle Measurements and Post-KT Outcomes

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-08-23 DOI:10.1111/ctr.70281

Yi Liu, Harris Z. Whiteson, Jingyao Hong, Nidhi Ghildayal, Omid Shafaat, Clifford R. Weiss, Robert A. Pol, Aarti Mathur, Babak J. Orandi, Dorry L. Segev, Mara A. McAdams-DeMarco

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引用次数: 0

Abstract

Introduction

Early post-kidney transplant (KT) changes likely impact body composition, resulting in adverse post-KT outcomes. We estimated post-KT trajectories of computed tomography (CT)-based muscle quantity/quality and tested whether they were associated with mortality and death-censored graft loss (DCGL) among frail and nonfrail recipients.

Methods

We leveraged a cohort of 294 adult KT recipients (December 2008–February 2020) with CT measurements (muscle quantity: skeletal muscle index; muscle quality: skeletal muscle radiation attenuation). We used mixed linear regression models to estimate 3-year post-KT muscle quantity/quality trajectories. Cox proportional hazard models quantified the association between time-varying pre-/post-KT muscle mass measurements and post-KT mortality and DCGL.

Results

Muscle quantity (−2.4 cm²/m²/year) and quality (−1.3 HU/year) decreased during the first 2 years post-KT and then remained constant in the third year post-KT. Change in muscle quantity (p_interaction < 0.01) and quality (p_interaction = 0.01) differed by frailty in the first 2 years post-KT; change in muscle quality (p_interaction < 0.01) differed by lower extremity impairment in the third year post-KT. Among frail recipients, lower muscle quantity (per 10 cm²/m²) was associated with elevated mortality risk (aHR: 2.00, 95% CI: 1.08–3.70), but not among nonfrail recipients. Among older (≥65 years) recipients, lower muscle quantity was associated with increased DCGL risk (aHR: 2.70, 95% CI: 1.04–7.04), but not among younger recipients. Lower muscle quality (per 10 HU) was associated with elevated mortality (aHR: 2.23, 95% CI: 1.61–3.08) and DCGL (aHR: 1.90, 95% CI: 1.16–3.12) risk.

Conclusion

Lower pre-/post-KT muscle quantity/quality were associated with higher risks of post-KT adverse outcomes. Pre-/post-KT rehabilitation to improve muscle quantity/quality may be an effective clinical intervention to minimize risks of adverse post-KT outcomes.

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基于腹部计算机断层扫描的肾脏移植前后肌肉测量和kt后结果

早期肾移植后（KT）的变化可能影响身体成分，导致不良的KT后结果。我们估计了基于计算机断层扫描（CT）的肌肉数量/质量的kt后轨迹，并测试了它们是否与虚弱和非虚弱受者的死亡率和死亡审查移植损失（DCGL）相关。方法对294名成年KT受体（2008年12月至2020年2月）进行CT测量（肌肉量：骨骼肌指数；肌肉质量：骨骼肌辐射衰减）。我们使用混合线性回归模型来估计kt后3年肌肉数量/质量轨迹。Cox比例风险模型量化了随时间变化的kt前/后肌肉质量测量与kt后死亡率和DCGL之间的关系。结果肌肉量（- 2.4 cm2/m2/年）和质量（- 1.3 HU/年）在kt后的前2年下降，在kt后的第三年保持不变。肌量（p - interaction < 0.01）和质量（p - interaction = 0.01）的变化在kt后的前2年因虚弱程度不同而不同；肌肉质量的变化（p - interaction < 0.01）在kt后第三年因下肢损伤而不同。在体弱受者中，较低的肌肉量（每10 cm2/m2）与死亡风险升高相关（aHR: 2.00, 95% CI: 1.08-3.70），但在非体弱受者中则不然。在年龄较大（≥65岁）的受者中，较低的肌肉量与DCGL风险增加相关（aHR: 2.70, 95% CI: 1.04-7.04），但在年轻受者中无相关。较低的肌肉质量（每10 HU）与较高的死亡率（aHR: 2.23, 95% CI: 1.61-3.08）和DCGL （aHR: 1.90, 95% CI: 1.16-3.12）风险相关。结论较低的kt前/后肌肉数量/质量与较高的kt后不良结局相关。改善肌肉数量/质量的kt前/后康复可能是一种有效的临床干预措施，可将kt后不良结果的风险降至最低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.