Long-term evolution of body composition after renal transplantation: 5-year survey.
BACKGROUND
Thanks to advancements in immunosuppression, patients are living longer with kidney transplants, and nonimmunologic factors (particularly nutritional) have become a major source of morbidity and mortality after successful kidney transplantation (KTx). In this current study, we have prospectively assessed, in a cohort of kidney transplant recipients (KTR), the course of some nonimmunologic factors liable to hinder the long-term outcome of KTR.


METHODS
Forty-four consecutive KTR with stable functioning grafts received dietary recommendations and were on the lowest effective dose of steroids. Biochemical nutritional markers, C-reactive protein, lipid profile, and body composition determined by dual-energy X-ray absorptiometry were studied over the first year, 2 years, and 5 years after KTx.


RESULTS
No patients died during the follow-up. All patients but 2 were considered normotensive. Clinical diabetes developed in 3 patients. Visceral proteins stabilized at a normal range after the first year. Most of the patients normalized their inflammatory status. A significant improvement in lipid profile was observed. Female patients had a significant increase of weight (13.5%), mainly because of an increase in fat mass: 3.4 kg (19.4%) at 1 year and 5.6 kg (29.7%) at 2 years. In male patients, body composition remained stable and close to baseline values. The evolution of bone mass varied according to gender, total corticoid doses, and calcineurin inhibitors. Patients on low doses of steroids normalized their Z-score over the 5-year period. The increase in bone mass (paired t-test, P = .006) was only significant in patients treated with tacrolimus (analysis of variance for repeated measures, P < .001).


CONCLUSIONS
Simple measures and dietary intervention to prevent or correct nonimmunologic disorders should permit improvement of long-term morbidity and mortality of KTR without compromising the functional outcome of their transplant.
Moreau
Karine
K
Département de Néphrologie et de Transplantation Rénale, Centre Hospitalier Universitaire, Bordeaux, France.
Chauveau
Philippe
P
Martin
Séverine
S
El-Haggan
Wael
W
Barthe
Nicole
N
Merville
Pierre
P
Aparicio
Michel
M
D015502:Absorptiometry, Photon; D000328:Adult; D001794:Blood Pressure; D001823:Body Composition; D015992:Body Mass Index; D015519:Bone Density; D002097:C-Reactive Protein / Q000032:analysis; D002784:Cholesterol / Q000097:blood; D003404:Creatinine / Q000097:blood; D004032:Diet; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012709:Serum Albumin / Q000032:analysis; D014280:Triglycerides / Q000097:blood
D004041:Dietary Fats; D004044:Dietary Proteins; D007166:Immunosuppressive Agents; D012709:Serum Albumin; D014280:Triglycerides; D002097:C-Reactive Protein; D002784:Cholesterol; D003404:Creatinine