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Fukuhara H, Nishida H, Takai S, Nawano T, Takehara T, Takai Y, Narisawa T, Kanno H, Yagi M, Yamagishi A, Naito S, Tsuchiya N. Dialysis Duration, Time Interaction, and Visceral Fat Accumulation: A 6-Year Posttransplantation Study. Clin Exp Nephrol 2024:10.1007/s10157-024-02492-9. [PMID: 38658443 DOI: 10.1007/s10157-024-02492-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/19/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Kidney transplantation (KT) leads to body composition change, particularly increasing the fat mass. However, limited researches have focused on the long-term follow-up of these changes and factors influencing body composition after KT. METHODS This study evaluated body composition in 31 adult KT recipients, measuring body mass index (BMI), the psoas muscle mass index (PMI) representing muscle mass, visceral and subcutaneous adipose tissue (VAT and SAT) representing fat mass, and skeletal muscle radiodensity (SMR) representing muscle quality before KT and at 2, 4, and 6 years posttransplantation using computed tomography. Linear mixed models (LMM) analyzed temporal changes and contributing factors, while growth curve models assessed influence of these factors on body composition changes posttransplantation. RESULTS Following KT, BMI, and PMI remained stable, while SAT increased significantly, revealing a 1.30-fold increase from baseline 2 years after transplantation. Similarly, a substantial increase in VAT was observed, with a 1.47-fold increase from baseline 2 years after transplantation with a further 1.75-fold increase 6 years after transplantation. In contrast, SMR decreased with a 0.86-fold decrease from baseline after 2 years. VAT increase was significantly influenced by the interaction between posttransplantation and dialysis duration. Growth curve models confirmed this interaction effect persistently influenced VAT increase posttransplantation. CONCLUSIONS The study revealed that KT promoted significant alterations in body composition characterized by increase in the VAT and SAT and a decline in SMR. Notably, dialysis duration and its interaction with posttransplantation duration emerged as significant factors influencing VAT increase.
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Affiliation(s)
- Hiroki Fukuhara
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Hayato Nishida
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Satoshi Takai
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Takaaki Nawano
- Department of Cardiology, Pulmonology, and Nephrology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Tomohiro Takehara
- Department of Cardiology, Pulmonology, and Nephrology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yuki Takai
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Takafui Narisawa
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Hidenori Kanno
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Mayu Yagi
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Atsushi Yamagishi
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Sei Naito
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Norihiko Tsuchiya
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
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Chen J, Li Y, Li C, Song T. Myosteatosis is associated with poor survival after kidney transplantation: a large retrospective cohort validation. Abdom Radiol (NY) 2024; 49:1210-1222. [PMID: 38326665 DOI: 10.1007/s00261-023-04180-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE We aim to establish diagnostic thresholds of sarcopenia and myosteatosis based on CT measurements, and to validate their prognostic value in a large cohort of kidney transplant recipients. METHODS Local healthy population with abdominal CT between 2010 and 2022, and patients underwent kidney transplantation between 2015 and 2019 at our center were retrospectively included. The skeletal muscle index and muscle attenuation of abdominal muscles were calculated based on CT image at the middle of the third lumbar vertebra. Primary endpoints included all-cause mortality and death censored allograft survival. RESULTS Age- and sex-specific thresholds for sarcopenia and myosteatosis were established based on 1598 healthy local population. The final patient cohort consisted of 992 kidney transplant recipients (median age 34 years, interquartile range 28-44 years; 694 males), including 33 (3.3%) with sarcopenia and 95 (9.5%) with myosteatosis. Multivariate analysis revealed myosteatosis (adjusted hazard ratio = 3.08, p = 0.022) was an independent baseline risk factor of mortality after adjusting for age, the history of cancer, and the history of cardiovascular event. Multivariate analysis found preemptive transplantation (adjusted hazard ratio = 0.36, p = 0.037) was an independent protective factor of allograft loss. No difference was found in the prognosis between kidney transplant recipients with and without sarcopenia. CONCLUSION Myosteatosis was an independent risk factor of mortality after kidney transplantation, but sarcopenia was not. Neither sarcopenia nor myosteatosis was associated with graft loss.
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Affiliation(s)
- Jie Chen
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
| | - Yue Li
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
- Transplant Center, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Chengjie Li
- Department of Radiology, Chongqing Southeast Hospital, No. 98, Tongjiang Avenue, Nan'an District, Chongqing, China
| | - Turun Song
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
- Transplant Center, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.
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Li Y, Chen J, Tang Y, Lin T, Song T. Effect of pretransplant sarcopenia on patient and graft outcomes in solid organ transplant recipients: A systematic review and meta-analysis. Asian J Surg 2024; 47:1723-1733. [PMID: 38169165 DOI: 10.1016/j.asjsur.2023.12.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/10/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
The relationship between sarcopenia and prognosis in solid organ transplantation recipients (SOTr) remains unverified. We aimed to quantify the prevalence of pretransplant sarcopenia and its effect on patient and graft survival in SOTr. We used PubMed, EMBASE, Cochrane Library and Web of Science to search relevant studies published in English (from inception to December 31, 2021). Prospective and retrospective cohort studies that reported the prevalence of sarcopenia before transplant or the association between sarcopenia and clinical outcomes in SOTr were included. Primary outcomes were the prevalence of sarcopenia and its impact on patient and graft survival. Secondary outcomes included perioperative complications, acute rejection, length of hospital stay, length of intensive care unit stay (ICU LOS) and early readmission. Thirty-nine studies involving 5792 patients were included. Pooled prevalence of sarcopenia amongst SOTr candidates was 40 % (95 % confidence interval [CI]: 34%-47 % and I2 = 97 %). Sarcopenia was associated with increased risk of death (hazard ratio [HR] = 1.87, 95 % CI: 1.46-2.41 and I2 = 60 %), poor graft survival (HR = 1.71, 95 % CI: 1.16-2.54 and I2 = 57 %) and increased liver graft loss (HR = 1.43, 95 % CI: 1.03-1.99 and I2 = 38 %). Patients with sarcopenia demonstrated increased incidence of perioperative complications (risk ratio [RR] = 1.34, 95 % CI: 1.17-1.53 and I2 = 40 %), long ICU LOS (mean difference = 2.31 days, 95 % CI: 0.58-4.04 and I2 = 97 %) and decreased risk of acute rejection (RR = 0.61, 95 % CI: 0.42-0.89 and I2 = 0 %). In Conclusion, sarcopenia is prevalent in SOTr candidates and associated with death and graft loss. Identifying sarcopenia before transplantation and intervening may improve long-term outcomes.
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Affiliation(s)
- Yue Li
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 61004, China; Transplant Center, West China Hospital, Sichuan University, Chengdu, 61004, China
| | - Jie Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 61004, China
| | - Yangming Tang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 61004, China; Transplant Center, West China Hospital, Sichuan University, Chengdu, 61004, China
| | - Tao Lin
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 61004, China; Transplant Center, West China Hospital, Sichuan University, Chengdu, 61004, China
| | - Turun Song
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 61004, China; Transplant Center, West China Hospital, Sichuan University, Chengdu, 61004, China.
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Quint EE, Liu Y, Shafaat O, Ghildayal N, Crosby H, Kamireddy A, Pol RA, Orandi BJ, Segev DL, Weiss CR, McAdams-DeMarco MA. Abdominal computed tomography measurements of body composition and waitlist mortality in kidney transplant candidates. Am J Transplant 2024; 24:591-605. [PMID: 37949413 PMCID: PMC10982050 DOI: 10.1016/j.ajt.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/10/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
Body mass index is often used to determine kidney transplant (KT) candidacy. However, this measure of body composition (BC) has several limitations, including the inability to accurately capture dry weight. Objective computed tomography (CT)-based measures may improve pre-KT risk stratification and capture physiological aging more accurately. We quantified the association between CT-based BC measurements and waitlist mortality in a retrospective study of 828 KT candidates (2010-2022) with clinically obtained CT scans using adjusted competing risk regression. In total, 42.5% of candidates had myopenia, 11.4% had myopenic obesity (MO), 68.8% had myosteatosis, 24.8% had sarcopenia (probable = 11.2%, confirmed = 10.5%, and severe = 3.1%), and 8.6% had sarcopenic obesity. Myopenia, MO, and sarcopenic obesity were not associated with mortality. Patients with myosteatosis (adjusted subhazard ratio [aSHR] = 1.62, 95% confidence interval [CI]: 1.07-2.45; after confounder adjustment) or sarcopenia (probable: aSHR = 1.78, 95% CI: 1.10-2.88; confirmed: aSHR = 1.68, 95% CI: 1.01-2.82; and severe: aSHR = 2.51, 95% CI: 1.12-5.66; after full adjustment) were at increased risk of mortality. When stratified by age, MO (aSHR = 2.21, 95% CI: 1.28-3.83; P interaction = .005) and myosteatosis (aSHR = 1.95, 95% CI: 1.18-3.21; P interaction = .038) were associated with elevated risk only among candidates <65 years. MO was only associated with waitlist mortality among frail candidates (adjusted hazard ratio = 2.54, 95% CI: 1.28-5.05; P interaction = .021). Transplant centers should consider using BC metrics in addition to body mass index when a CT scan is available to improve pre-KT risk stratification at KT evaluation.
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Affiliation(s)
- Evelien E Quint
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Yi Liu
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Omid Shafaat
- Division of Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nidhi Ghildayal
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Helen Crosby
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Arun Kamireddy
- Division of Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert A Pol
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Babak J Orandi
- Division of Endocrinology, Joan & Sanford Weill Medical College of Cornell University, New York, NY, USA
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
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5
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Liu FP, Guo MJ, Yang Q, Li YY, Wang YG, Zhang M. Myosteatosis is associated with coronary artery calcification in patients with type 2 diabetes. World J Diabetes 2024; 15:429-439. [PMID: 38591084 PMCID: PMC10999038 DOI: 10.4239/wjd.v15.i3.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/19/2023] [Accepted: 02/20/2024] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND Myosteatosis, rather than low muscle mass, is the primary etiologic factor of sarcopenia in patients with type 2 diabetes mellitus (T2DM). Myosteatosis may lead to a series of metabolic dysfunctions, such as insulin resistance, systematic inflammation, and oxidative stress, and all these dysfunctions are closely associated with the acceleration of T2DM and atherosclerosis. AIM To investigate the association between myosteatosis and coronary artery calcification (CAC) in patients with T2DM. METHODS Patients with T2DM, who had not experienced major cardiovascular events and had undergone both abdominal and thoracic computed tomography (CT) scans, were included. The mean skeletal muscle attenuation was assessed using abdominal CT images at the L3 level. The CAC score was determined from thoracic CT images using the Agatston scoring method. Myosteatosis was diagnosed according to Martin's criteria. Severe CAC (SCAC) was defined when the CAC score exceeded 300. Logistic regression and decision tree analyses were performed. RESULTS A total of 652 patients with T2DM were enrolled. Among them, 167 (25.6%) patients had SCAC. Logistic regression analysis demonstrated that myosteatosis, age, duration of diabetes, cigarette smoking, and alcohol consumption were independent risk factors of SCAC. Myosteatosis was significantly associated with an increased risk of SCAC (OR = 2.381, P = 0.003). The association between myosteatosis and SCAC was significant in the younger patients (OR = 2.672, 95%CI: 1.477-4.834, P = 0.002), but not the older patients (OR = 1.456, 95%CI: 0.863-2.455, P = 0.188), and was more prominent in the population with lower risks of atherosclerosis. The decision tree analyses prioritized older age as the primary variable for SCAC. In older patients, cigarette smoking was the main contributing factor for SCAC, while in younger patients, it was myosteatosis. CONCLUSION Myosteatosis is a novel risk factor for atherosclerosis in patients with T2DM, especially in the population with younger ages and fewer traditional risk factors.
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Affiliation(s)
- Fu-Peng Liu
- The Affiliated Hospital of Medical College Qingdao University, Qingdao University, Qingdao 266071, Shandong Province, China
- Department of Endocrinology, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
| | - Mu-Jie Guo
- Department of Medical Imaging, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
| | - Qing Yang
- Department of Clinical Nutrition, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
| | - Yan-Ying Li
- Department of Endocrinology, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
| | - Yan-Gang Wang
- Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Mei Zhang
- Department of Endocrinology, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
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Hahn M, Wood A, Hasse JM. Nutrition support management of organ transplant recipients in the acute posttransplant phase. Nutr Clin Pract 2024; 39:45-58. [PMID: 38081296 DOI: 10.1002/ncp.11104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 01/13/2024] Open
Abstract
Patients who undergo solid organ transplant can have an extensive and challenging postoperative course. The chronicity of the disease state prior to transplant in combination with transplant-specific complications and immunosuppressant medications can lead to distinct challenges that are not observed in other critically ill patients. Although the manifestation of posttransplant complications may be specific to the organ being transplanted, there are common transplant challenges that affect nutrition therapy in these patients. Effects of malnutrition, metabolic aberrations, and posttransplant organ dysfunction should be considered when developing a nutrition care plan for patients in the immediate posttransplant phase. This article addresses the various complications that can arise in the immediate posttransplant phase among patients undergoing solid organ transplant and the appropriate nutrition interventions or considerations for this specialized patient population.
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Affiliation(s)
- Michaelann Hahn
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Abby Wood
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Jeanette M Hasse
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
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Kojima S, Usui N, Shigetake M, Uehata A, Inatsu A, Ando S, Matsuzawa R, Suzuki Y, Nakata J, Tsuchiya T, Hisadome H, Mawatari T, Tsubaki A. Intramuscular and abdominal fat measured by computed tomography and mortality of hemodialysis patients. Nephrol Dial Transplant 2024; 39:286-296. [PMID: 37458763 DOI: 10.1093/ndt/gfad169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND In hemodialysis patients, high body mass index is associated with low mortality while abdominal obesity relates to increased mortality. We aimed to investigate the association between muscle mass, intramuscular fat and abdominal fat measured by abdominal computed tomography (CT), and mortality in this patients population. METHODS This two-center retrospective cohort study included hemodialysis patients who underwent abdominal CT between January 2013 and December 2018. Skeletal muscle mass index (SMI), muscle radiation attenuation (MRA) as an index of intramuscular fat, and visceral fat to subcutaneous fat ratio (VSR) were calculated using CT images at the third lumbar vertebral level. Multivariate Cox proportional hazards model was used to determine the independent predictors of all-cause, cardiovascular and non-cardiovascular mortalities. RESULTS The study included 344 patients (median age 71.0 years; female 33.7%), among whom 145 died during a median follow-up of 4.9 years-46 and 99 from cardiovascular and non-cardiovascular causes, respectively. Lower MRA [hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.58-0.87, P = .001] and higher VSR (HR 1.17, 95% CI 1.01-1.37, P = .04) were independently associated with higher all-cause mortality but not with lower SMI (HR 0.87, 95% CI 0.68-1.11, P = .26). Lower MRA (HR 0.51, 95% CI 0.35-0.73, P < .001) and higher VSR (HR 1.29, 95% CI 1.09-1.54, P = .003) were also associated with cardiovascular and non-cardiovascular mortality, respectively. CONCLUSIONS Intramuscular fat and abdominal fat as measured using abdominal CT in hemodialysis patients are stronger independent predictors of mortality than muscle mass.
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Affiliation(s)
- Sho Kojima
- Department of Rehabilitation, Kisen Hospital, Tokyo, Katsushika-ku, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata-city, Niigata, Japan
| | - Naoto Usui
- Department of Rehabilitation, Kisen Hospital, Tokyo, Katsushika-ku, Japan
- Department of Nephrology, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Masato Shigetake
- Department of Radiology, Kisen Hospital, Katsushika-ku, Tokyo, Japan
| | - Akimi Uehata
- Division of Cardiology, Kisen Hospital, Katsushika-ku, Tokyo, Japan
| | - Akihito Inatsu
- Division of Nephrology, Kisen Hospital, Katsushika-ku, Tokyo, Japan
| | - Shuji Ando
- Department of Information Sciences, Tokyo University of Science, Noda-city, Chiba, Japan
| | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Kobe-city, Hyogo Medical University, Hyogo, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Junichiro Nakata
- Department of Nephrology, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Takahiko Tsuchiya
- Division of Internal Medicine, Kisen Hospital, Katsushika-ku, Tokyo, Japan
| | - Hideki Hisadome
- Division of Cardiology, Kisen Hospital, Katsushika-ku, Tokyo, Japan
| | - Takayuki Mawatari
- Division of Internal Medicine, Kisen Hospital, Katsushika-ku, Tokyo, Japan
| | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata-city, Niigata, Japan
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Wakamiya T, Fujimoto T, Endo T, Nishioka S, Yokoyama N, Yamashita S, Kikkawa K, Hyodo Y, Ishimura T, Kohjimoto Y, Hara I, Fujisawa M. Myosteatosis as a novel predictor of new-onset diabetes mellitus after kidney transplantation. Int J Urol 2024; 31:39-44. [PMID: 37743534 DOI: 10.1111/iju.15304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES We evaluate the effect of myosteatosis on new-onset diabetes mellitus after kidney transplantation. METHODS Consecutive patients who had renal transplant between 2006 and 2021 were reviewed, and 219 patients were finally included. Psoas muscle index was used to evaluate sarcopenia and average total psoas density (calculated by computed tomography before surgery) for myosteatosis. We used Cox proportional regression analyses in investigation of whether skeletal muscle depletion before surgery inclusive of sarcopenia and myosteatosis is a new additional predictor of new-onset diabetes mellitus. RESULTS Median recipient age and body mass index were 45 years and 21.1 kg/m2 , respectively, and 123 patients (56%) were male. Preoperative impaired glucose tolerance was present in 58 patients (27%) and new-onset diabetes mellitus in 30 patients (14%), with median psoas muscle index of 6 cm2 /m2 and average total psoas density of 41 Hounsfield Unit. In multivariate analysis, significant risk factors were body mass index ≥25 kg/m2 (p < 0.01), impaired glucose tolerance (p < 0.01), and average total psoas density < 41.9 Hounsfield Unit (p = 0.03). New-onset diabetes mellitus had incidence rates of 3.7% without risk factors, 10% with a single risk factor, 33% with two, and 60% with three. Patients with new-onset diabetes mellitus were effectively stratified by the number of risk factors (p < 0.01). CONCLUSIONS Myosteatosis could be a new risk factor used to predict new-onset diabetes mellitus.
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Affiliation(s)
- Takahito Wakamiya
- Department of Urology, Wakayama Medical University, Wakayama, Japan
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takuya Fujimoto
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takahito Endo
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shun Nishioka
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Naoki Yokoyama
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | | | - Kazuro Kikkawa
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Yoji Hyodo
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takeshi Ishimura
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Nachit M, Horsmans Y, Summers RM, Leclercq IA, Pickhardt PJ. AI-based CT Body Composition Identifies Myosteatosis as Key Mortality Predictor in Asymptomatic Adults. Radiology 2023; 307:e222008. [PMID: 37191484 PMCID: PMC10315523 DOI: 10.1148/radiol.222008] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 03/19/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023]
Abstract
Background Body composition data have been limited to adults with disease or older age. The prognostic impact in otherwise asymptomatic adults is unclear. Purpose To use artificial intelligence-based body composition metrics from routine abdominal CT scans in asymptomatic adults to clarify the association between obesity, liver steatosis, myopenia, and myosteatosis and the risk of mortality. Materials and Methods In this retrospective single-center study, consecutive adult outpatients undergoing routine colorectal cancer screening from April 2004 to December 2016 were included. Using a U-Net algorithm, the following body composition metrics were extracted from low-dose, noncontrast, supine multidetector abdominal CT scans: total muscle area, muscle density, subcutaneous and visceral fat area, and volumetric liver density. Abnormal body composition was defined by the presence of liver steatosis, obesity, muscle fatty infiltration (myosteatosis), and/or low muscle mass (myopenia). The incidence of death and major adverse cardiovascular events were recorded during a median follow-up of 8.8 years. Multivariable analyses were performed accounting for age, sex, smoking status, myosteatosis, liver steatosis, myopenia, type 2 diabetes, obesity, visceral fat, and history of cardiovascular events. Results Overall, 8982 consecutive outpatients (mean age, 57 years ± 8 [SD]; 5008 female, 3974 male) were included. Abnormal body composition was found in 86% (434 of 507) of patients who died during follow-up. Myosteatosis was found in 278 of 507 patients (55%) who died (15.5% absolute risk at 10 years). Myosteatosis, obesity, liver steatosis, and myopenia were associated with increased mortality risk (hazard ratio [HR]: 4.33 [95% CI: 3.63, 5.16], 1.27 [95% CI: 1.06, 1.53], 1.86 [95% CI: 1.56, 2.21], and 1.75 [95% CI: 1.43, 2.14], respectively). In 8303 patients (excluding 679 patients without complete data), after multivariable adjustment, myosteatosis remained associated with increased mortality risk (HR, 1.89 [95% CI: 1.52, 2.35]; P < .001). Conclusion Artificial intelligence-based profiling of body composition from routine abdominal CT scans identified myosteatosis as a key predictor of mortality risk in asymptomatic adults. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Tong and Magudia in this issue.
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Affiliation(s)
- Maxime Nachit
- From the Laboratory of Hepato-Gastroenterology, Institut de Recherche
Expérimentale et Clinique, UCLouvain, Brussels, Belgium (M.N., I.A.L.);
Service d'Hépato-Gastro-Entérologie, Cliniques
Universitaires Saint-Luc, Brussels, Belgium (Y.H.); Imaging Biomarkers and
Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National
Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); and Department of
Radiology, University of Wisconsin School of Medicine & Public Health,
Madison, Wis (P.J.P.)
| | - Yves Horsmans
- From the Laboratory of Hepato-Gastroenterology, Institut de Recherche
Expérimentale et Clinique, UCLouvain, Brussels, Belgium (M.N., I.A.L.);
Service d'Hépato-Gastro-Entérologie, Cliniques
Universitaires Saint-Luc, Brussels, Belgium (Y.H.); Imaging Biomarkers and
Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National
Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); and Department of
Radiology, University of Wisconsin School of Medicine & Public Health,
Madison, Wis (P.J.P.)
| | - Ronald M. Summers
- From the Laboratory of Hepato-Gastroenterology, Institut de Recherche
Expérimentale et Clinique, UCLouvain, Brussels, Belgium (M.N., I.A.L.);
Service d'Hépato-Gastro-Entérologie, Cliniques
Universitaires Saint-Luc, Brussels, Belgium (Y.H.); Imaging Biomarkers and
Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National
Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); and Department of
Radiology, University of Wisconsin School of Medicine & Public Health,
Madison, Wis (P.J.P.)
| | - Isabelle A. Leclercq
- From the Laboratory of Hepato-Gastroenterology, Institut de Recherche
Expérimentale et Clinique, UCLouvain, Brussels, Belgium (M.N., I.A.L.);
Service d'Hépato-Gastro-Entérologie, Cliniques
Universitaires Saint-Luc, Brussels, Belgium (Y.H.); Imaging Biomarkers and
Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National
Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); and Department of
Radiology, University of Wisconsin School of Medicine & Public Health,
Madison, Wis (P.J.P.)
| | - Perry J. Pickhardt
- From the Laboratory of Hepato-Gastroenterology, Institut de Recherche
Expérimentale et Clinique, UCLouvain, Brussels, Belgium (M.N., I.A.L.);
Service d'Hépato-Gastro-Entérologie, Cliniques
Universitaires Saint-Luc, Brussels, Belgium (Y.H.); Imaging Biomarkers and
Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National
Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); and Department of
Radiology, University of Wisconsin School of Medicine & Public Health,
Madison, Wis (P.J.P.)
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10
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Gaillard F, Bienaime F. Comment on 'Allograft function and muscle mass evolution after kidney transplantation' by Gaillard et al.: The authors reply. J Cachexia Sarcopenia Muscle 2023. [PMID: 36883476 DOI: 10.1002/jcsm.13202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Affiliation(s)
| | - Frank Bienaime
- Université Paris Cité, Paris, Île-de-France, France.,Service d'Explorations Fonctionnelles, Hôpital Necker Enfants Malades, APHP, Paris, France
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11
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Stehlé T, Morel A, Ouamri Y, Pigneur F. Comment on 'Allograft function and muscle mass evolution after kidney transplantation' by Gaillard et al. J Cachexia Sarcopenia Muscle 2023; 14:1139-1141. [PMID: 36869595 PMCID: PMC10067480 DOI: 10.1002/jcsm.13203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Affiliation(s)
- Thomas Stehlé
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France
| | - Antoine Morel
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France
| | - Yaniss Ouamri
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
| | - Frédéric Pigneur
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
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12
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Mesropyan N, Khorsandian L, Faron A, Sprinkart AM, Dorn F, Paech D, Isaak A, Kuetting D, Pieper CC, Radbruch A, Attenberger UI, Reimann J, Bode FJ, Kornblum C, Luetkens JA. Computed tomography derived cervical fat-free muscle fraction as an imaging-based outcome marker in patients with acute ischemic stroke: a pilot study. BMC Neurol 2023; 23:86. [PMID: 36855093 PMCID: PMC9971678 DOI: 10.1186/s12883-023-03132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 02/19/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Outcome assessment in stroke patients is essential for evidence-based stroke care planning. Computed tomography (CT) is the mainstay of diagnosis in acute stroke. This study aimed to investigate whether CT-derived cervical fat-free muscle fraction (FFMF) as a biomarker of muscle quality is associated with outcome parameters after acute ischemic stroke. METHODS In this retrospective study, 66 patients (mean age: 76 ± 13 years, 30 female) with acute ischemic stroke in the anterior circulation who underwent CT, including CT-angiography, and endovascular mechanical thrombectomy of the middle cerebral artery between August 2016 and January 2020 were identified. Based on densitometric thresholds, cervical paraspinal muscles covered on CT-angiography were separated into areas of fatty and lean muscle and FFMF was calculated. The study cohort was binarized based on median FFMF (cutoff value: < 71.6%) to compare clinical variables and outcome data between two groups. Unpaired t test and Mann-Whitney U test were used for statistical analysis. RESULTS National Institute of Health Stroke Scale (NIHSS) (12.2 ± 4.4 vs. 13.6 ± 4.5, P = 0.297) and modified Rankin scale (mRS) (4.3 ± 0.9 vs. 4.4 ± 0.9, P = 0.475) at admission, and pre-stroke mRS (1 ± 1.3 vs. 0.9 ± 1.4, P = 0.489) were similar between groups with high and low FFMF. NIHSS and mRS at discharge were significantly better in patients with high FFMF compared to patients with low FFMF (NIHSS: 4.5 ± 4.4 vs. 9.5 ± 6.7; P = 0.004 and mRS: 2.9 ± 2.1 vs.3.9 ± 1.8; P = 0.049). 90-day mRS was significantly better in patients with high FFMF compared to patients with low FFMF (3.3 ± 2.2 vs. 4.3 ± 1.9, P = 0.045). CONCLUSION Cervical FFMF obtained from routine clinical CT might be a new imaging-based muscle quality biomarker for outcome prediction in stroke patients.
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Affiliation(s)
- Narine Mesropyan
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - Louisa Khorsandian
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,grid.15090.3d0000 0000 8786 803XDepartment of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Anton Faron
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany ,Radiologische Allianz, Andreas-Knack-Ring 16, 22307 Hamburg, Germany
| | - Alois M. Sprinkart
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - Franziska Dorn
- grid.15090.3d0000 0000 8786 803XDepartment of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel Paech
- grid.15090.3d0000 0000 8786 803XDepartment of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Isaak
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel Kuetting
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - Claus C. Pieper
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Radbruch
- grid.15090.3d0000 0000 8786 803XDepartment of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ulrike I. Attenberger
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jens Reimann
- grid.15090.3d0000 0000 8786 803XDepartment of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Felix J. Bode
- grid.15090.3d0000 0000 8786 803XDepartment of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Cornelia Kornblum
- grid.15090.3d0000 0000 8786 803XDepartment of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Julian A. Luetkens
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
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13
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Zhang JZ, Shi W, Zou M, Zeng QS, Feng Y, Luo ZY, Gan HT. Diagnosis, prevalence, and outcomes of sarcopenia in kidney transplantation recipients: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2023; 14:17-29. [PMID: 36403578 PMCID: PMC9891953 DOI: 10.1002/jcsm.13130] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/14/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022] Open
Abstract
The prevalence of sarcopenia and its clinical predictors and clinical impact vary among kidney transplant recipients (KTRs), in part because of different diagnostic criteria. This study aimed to assess the reported diagnosis criteria of sarcopenia and compare them in terms of prevalence, clinical predictors, and impact of sarcopenia. The Medline, Embase, and Cochrane Library were searched for the full-length reports published until 28 January 2022. The subgroup analysis, meta-regression, and sensitivity analysis were performed and heterogeneity was assessed using the I2 . A total of 681 studies were retrieved, among which only 23 studies (including 2535 subjects, 59.7% men, mean age 49.8 years) were eventually included in the final analysis. The pooled prevalence in these included studies was 26% [95% confidence interval (95% CI): 20-34%, I2 = 93.45%], including 22% (95% CI: 14-32%, I2 = 88.76%) in men and 27% (95% CI: 14-41%, I2 = 90.56%) in women (P = 0.554 between subgroups). The prevalence of sarcopenia diagnosed using low muscle mass was 34% (95% CI: 21-48%, I2 = 95.28%), and the prevalence of using low muscle mass in combination with low muscle strength and/or low physical performance was 21% (95% CI: 15-28%, I2 = 90.37%) (P = 0.08 between subgroups). In meta-regression analyses, the mean age (regression coefficient: 1.001, 95% CI: 0.991-1.011) and percentage male (regression coefficient: 0.846, 95% CI: 0.367-1.950) could not predict the effect size. Lower body mass index (odds ratio (OR): 0.57, 95% CI: 0.39-0.84, I2 = 61.5%), female sex (OR: 0.31, 95% CI: 0.16-0.61, I2 = 0.0%), and higher age (OR: 1.08, 95% CI: 1.05-1.10, I2 = 10.1%) were significantly associated with a higher risk for sarcopenia in KTRs, but phase angle (OR: 0.81, 95% CI: 0.16-4.26, I2 = 84.5%) was not associated with sarcopenia in KTRs. Sarcopenia was not associated with rejections (risk ratio (RR): 0.67, 95% CI: 0.23-1.92, I2 = 12.1%), infections (RR: 1.03, 95% CI: 0.34-3.12, I2 = 87.4%), delayed graft functions (RR: 0.81, 95% CI: 0.46-1.43, I2 = 0.0%), and death (RR: 0.95, 95% CI: 0.32-2.82, I2 = 0.0%) in KRTs. Sarcopenia was found to be very common in KRTs. However, we have not found that sarcopenia had a negative impact on clinical health after kidney transplantation. Large study cohorts and multicentre longitudinal studies in the future are urgently needed to explore the prevalence and prognosis of sarcopenia in kidney transplant patients.
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Affiliation(s)
- Jin-Zhi Zhang
- Department of Infectious Disease Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Shi
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Min Zou
- Lab of Inflammatory Bowel Disease, The Center for Inflammatory Bowel Disease, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi-Shan Zeng
- Lab of Inflammatory Bowel Disease, The Center for Inflammatory Bowel Disease, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Feng
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhen-Yi Luo
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hua-Tian Gan
- Lab of Inflammatory Bowel Disease, The Center for Inflammatory Bowel Disease, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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14
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Beau M, Barbieux J, Bigot P, Piquet J, Aupert G, Duveau A, Lebdai S, Planchais M, Augusto JF, Culty T. Study of Post-Kidney Transplantation Parietal Complications and Presarcopenia. Transplant Proc 2023; 55:116-122. [PMID: 36564320 DOI: 10.1016/j.transproceed.2022.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/12/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Sarcopenia is defined as a loss of muscle mass and strength. Its effects on postoperative outcomes in oncology and geriatrics have already been shown. Approximately 40% of patients in end-stage renal failure are affected with sarcopenia. A recent study suggests that sarcopenia could predict surgical complications after renal transplantation in obese patients. The aim of this study was to evaluate the effect of sarcopenia on parietal complications (eg, wound healing, lymphocele, hematoma). METHODS Two indices of muscle fat infiltration (intra-muscular adipose content [IMAC], Hounsfield unit average calculation [HUAC]) and 3 of muscle mass index (total psoas index [TPI], visceral fat area/total abdominal muscle area [VFA/TAMA], and skeletal muscle mass index [SMMI]) were retrospectively measured on pretransplant computed tomography scans for patients undergoing kidney transplantation between 2007 and 2017. Patients were considered sarcopenic when the index was above the third quartile for muscle fat infiltration (IMAC, HUAC) and VFA/TAMA, and under the first quartile for muscle mass (TPI, SMMI). The occurrence of wound healing, collection (hematoma and lymphocele), and acute rejection were compared between sarcopenic and nonsarcopenic patients. RESULTS Of 484 transplanted patients, 117 patients had a computed tomography scan before transplantation. Patients with a high HUAC had significantly more collections (P = .02) and total parietal complications (P = .09). Patients with a high IMAC had significantly more acute rejection (P = .001). CONCLUSIONS Muscle fat infiltration appears to influence the outcome of renal transplantation. The management of sarcopenia in pretransplantation should be a subject of further research.
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Affiliation(s)
- Marion Beau
- Service urologie, Centre Hospitalier Universitaire, Angers, France.
| | - Julien Barbieux
- Service de chirurgie visceral, Centre Hospitalier, Le Mans, France
| | - Pierre Bigot
- Service urologie, Centre Hospitalier Universitaire, Angers, France
| | - Jean Piquet
- Service chirurgie vasculaire et thoracique, Centre Hospitalier Universitaire, Angers, France
| | - Gauthier Aupert
- Service chirurgie vasculaire et thoracique, Centre Hospitalier Universitaire, Angers, France
| | - Agnes Duveau
- Service de néphrologie, Centre Hospitalier Universitaire, Angers, France
| | - Souhil Lebdai
- Service urologie, Centre Hospitalier Universitaire, Angers, France
| | - Martin Planchais
- Service de néphrologie, Centre Hospitalier Universitaire, Angers, France
| | | | - Thibaut Culty
- Service urologie, Centre Hospitalier Universitaire, Angers, France
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15
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Westenberg LB, Zorgdrager M, Viddeleer AR, Pol RA. Defining sarcopenia and myosteatosis: the necessity for consensus on a technical standard and standardized cut-off values. J Cachexia Sarcopenia Muscle 2022; 13:1429-1430. [PMID: 35218312 PMCID: PMC8977957 DOI: 10.1002/jcsm.12961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Lisa B Westenberg
- Department of Surgery, Division of Transplant Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marcel Zorgdrager
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alain R Viddeleer
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert A Pol
- Department of Surgery, Division of Transplant Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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