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Article Dans Une Revue Journal of Cachexia, Sarcopenia and Muscle Année : 2022

Allograft function and muscle mass evolution after kidney transplantation

François Gaillard
Mélissa Ould Rabah
  • Fonction : Auteur
Malik Touam
  • Fonction : Auteur
Antoine Neuraz
  • Fonction : Auteur
Christophe Legendre
  • Fonction : Auteur
Dany Anglicheau
  • Fonction : Auteur
Dominique Prié
  • Fonction : Auteur
Frank Bienaimé

Résumé

Abstract Background Advanced chronic kidney disease is associated with muscle wasting, but how glomerular filtration rate (GFR) recovery after kidney transplantation is associated with muscle mass is unknown. Methods We took advantage of the simultaneous measurement of GFR (using iohexol plasma clearance; ioGFR) and creatinine excretion rate (a surrogate marker of muscle mass; CER) performed 3 months after transplantation and at a later time point at our institution to investigate the interplay between allograft function, muscle mass, and outcome in kidney transplant recipients. Results Between June 2005 and October 2019, 1319 successive kidney transplant recipients (mean age 50.4 ± 14.6; 38.7% female) underwent GFR measurement at our institution 3 months after kidney transplantation. CER (CER 3 ) and ioGFR (ioGFR 3 ) were 7.7 ± 2.6 μmol/min and 53 ± 17.1 mL/min/1.73 m 2 , respectively. Multivariable analysis identified female gender, older donor and recipient age, reduced body mass index, coronary disease, dialysis history, proteinuria, and reduced ioGFR 3 as independent predictors of low CER 3 (ioGFR 3 : β coefficient 0.19 [95% confidence interval 0.14 to 0.24]). A total of 1165 patients had a subsequent CER measurement after a median follow‐up of 9.5 months. Of them, 373 (32%) experienced an increase in CER > 10%, while 222 (19%) showed a CER decrease of more than 10%. Multivariable analysis adjusted for CER 3 and other confounders identified ioGFR 3 as an independent predictor of CER at follow‐up ( β coefficient 0.11 [95% confidence interval 0.07 to 0.16]). In multivariable Cox analysis, reduced CER at 3 months or at follow‐up were consistently associated with mortality (hazard ratio [95% confidence interval] at 3 months: 0.82 [0.74 to 0.91]; at follow‐up: 0.79 [0.69 to 0.99]) but not with graft loss. Conclusions Glomerular filtration rate recovery is a determinant of muscle mass variation after kidney transplantation. Early interventions targeting muscle mass gain may be beneficial for kidney transplant recipients.

Dates et versions

hal-04339560 , version 1 (13-12-2023)

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François Gaillard, Mélissa Ould Rabah, Nicolas Garcelon, Malik Touam, Antoine Neuraz, et al.. Allograft function and muscle mass evolution after kidney transplantation. Journal of Cachexia, Sarcopenia and Muscle, 2022, 13 (6), pp.2875-2887. ⟨10.1002/jcsm.13066⟩. ⟨hal-04339560⟩
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