*Purpose: Body composition is associated with prognosis in a range of clinical settings, and patients with renal failure usually have significant comorbidities and are high risk for short and long-term morbidity and mortality. We aimed to assess the effect of sarcopenia and obesity on kidney transplantation outcomes.

*Methods: We performed a retrospective analysis of patients with kidney transplants between 2012-2016 with a CT scan within 3 years of transplantation. Skeletal muscle index (SMI, skeletal muscle area/height²) at the L3 vertebrae were used to evaluate sarcopenia. Patients were divided into four groups: sarcopenic obese, sarcopenic non-obese, non-sarcopenic non-obese, and non-sarcopenic obese, with 5 years follow up. BMI>25 was considered obese sarcopenia was defined as SMI<40.31cm²/m² in males and >30.88cm^2/m² in females. Obesity and sarcopenia were also assessed individually. Univariate and multivariate analysis were performed to compare outcomes.

*Results: 174 patients were included in this study. 3 month graft function was significantly lower in obese patients (eGFR 39 vs 46ml/min, p=0.04) but not at other timepoints (1 month, 1, 3, and 5years). Sarcopenia alone was associated with lower eGFR at 1 month (33 vs 44ml/min, p=0.049), but there was no long-term difference. Sarcopenic obese patients had lower eGFR at 1 month, 3 months, 1 year and 3 years (p=0.004, 0.022, 0.009, 0.048). They also had poorer graft survival (p=0.029), although patient survival remained similar (p=0.60). In multivariate analysis adjusted for diabetes, cardiac disease, and pre-transplant dialysis modality, sarcopenic and sarcopenic obese patients had increased rates of major adverse cardiac events (OR 3.41, p=0.036 and OR 26.06, <0.001) but these effects were not seen by simple obesity assessment. There was no difference in DGF or post-operative complications across all groups.

*Conclusions: Sarcopenic obesity is associated with increased morbidity in kidney transplantation, and sarcopenic obese patients have poorer outcomes compared to patients with sarcopenia or obesity alone.

« Back to 2022 American Transplant Congress