Background: Morphometric assessments, such as muscle density and body fat distribution, have emerged as strong predictors of cardiovascular risk and post-operative morbidity and mortality. To date, no study has examined morphometric mortality risk prediction among kidney transplant (KT) candidates.

Methods: KT candidates, waitlisted 2008-2009 and with clinical CT imaging available at the time of listing, were identified (n=80) and followed to the earliest of transplant, death, or administrative end of study. Morphometric measures, including abdominal adipose tissue, paraspinous and psoas muscle composition, and aortic calcification, were assessed from CTs. Risk of mortality on the waitlist was examined using Cox proportional hazards regression adjusting for traditional (age, BMI, dialysis time) and morphometric (aortic calcification, muscle fat infiltration) factors.

Results: After a median of 3.8 years of follow-up (IQR: 1.2-6.1), 31 patients died while waiting, 23 patients were transplanted, and 26 were still awaiting KT. After controlling for multiple factors, only higher psoas muscle attenuation (indicative of leaner muscle) remained significantly associated with waitlist mortality, with a 7% decreased risk of death for every Hounsfield Unit increase in attenuation (aHR:0.93, 95%CI: 0.88-0.98, p=0.007)

Conclusion: Muscle density is independently associated with lower kidney waitlist mortality, and assessing muscle composition may help to improve mortality risk prediction and candidate selection.

CITATION INFORMATION: Reed R, Nair S, Smith G, Lewis C, Terry J, Carr J, Locke J. Muscle Density Is Associated with Mortality Among Kidney Waitlist Candidates. Am J Transplant. 2016;16 (suppl 3).

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