Changes in Body Composition, Muscle Strength, and Fat Distribution Following Renal Transplantation

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Background: The impact of renal transplantation on body composition and muscle quality has not been established. Low muscle mass relative to fat mass (relative sarcopenia) has been associated with mortality and disability but has not been examined following transplantation. Methods: DXA measures of fat mass index (FMI) and appendicular lean mass index (ALMI; representing muscle mass), CT measures of muscle density (low density represents increased intramuscular adipose tissue), and leg muscle strength were assessed in 60 transplant recipients (ages 20-60 years) at transplantation, and 6, 12, and 24 months after transplantation. ALMI relative to FMI (ALMFMI) is an established index of relative sarcopenia. Measures were expressed as age, sex, and race-specific Z-scores and compared with 327 healthy controls. Results: At transplantation, ALMI, ALMIFMI, muscle strength and muscle density Z-scores were lower vs. controls (all p≤0.001). Transplant recipients received glucocorticoids throughout. The prevalence of obesity increased from 18 to 45%. Although ALMI increased following transplantation (p<0.001) and was comparable to controls from 6 months onward, gains were outpaced by increases in FMI, resulting in persistent ALMIFMI deficits (mean Z-score -0.31 at 24 months, p=0.02 vs controls). Fat gains were disproportionately visceral in distribution (p<0.05). Muscle strength improved but remained low compared with controls independent of ALMI (p<0.05). Exercise increased in the early months following transplantation (p<0.05) but remained lower than controls (p=0.02). Conclusions: The two-year interval following renal transplantation was characterized by gains in muscle mass and strength that were outpaced by gains in fat mass resulting in persistent relative sarcopenia. Funding: NIDDK SupportChange in Body Composition Z-scores from baseline after Transplantation

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