title: Associations of pretransplant weight and muscle mass with mortality in renal transplant recipients.
abstract: OBJECTIVE
  The association between pretransplant body composition and posttransplant outcomes in renal transplant recipients is unclear. It was hypothesized that in hemodialysis patients higher muscle mass (represented by higher pretransplant serum creatinine level) and larger body size (represented by higher pretransplant body mass index [BMI]) are associated with better posttransplant outcomes.
  
  
  METHODS
  Linking 5-year patient data of a large dialysis organization (DaVita) to the Scientific Registry of Transplant Recipients, 10,090 hemodialysis patients were identified who underwent kidney transplantation from July 2001 to June 2007. Cox regression hazard ratios and 95% confidence intervals of death and/or graft failure were estimated.
  
  
  RESULTS
  Patients were 49 ± 13 years old and included 49% women, 45% diabetics, and 27% African Americans. In Cox models adjusted for case-mix, nutrition-inflammation complex, and transplant-related covariates, the 3-month-averaged postdialysis weight-based pretransplant BMI of 20 to <22 and < 20 kg/m(2), compared with 22 to <25 kg/m(2), showed a nonsignificant trend toward higher combined posttransplant mortality or graft failure, and even weaker associations existed for BMI ≥ 25 kg/m(2). Compared with pretransplant 3-month- averaged serum creatinine of 8 to <10 mg/dl, there was 2.2-fold higher risk of combined death or graft failure with serum creatinine <4 mg/dl, whereas creatinine ≥14 mg/dl exhibited 22% better graft and patient survival.
  
  
  CONCLUSIONS
  Pretransplant obesity does not appear to be associated with poor posttransplant outcomes. Larger pretransplant muscle mass, reflected by higher pretransplant serum creatinine level, is associated with greater posttransplant graft and patient survival.
authors.affiliation: Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90509-2910, USA.
authors.forename: Elani
authors.initials: E
authors.lastname: Streja
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
authors.forename: Suphamai
authors.initials: S
authors.lastname: Bunnapradist
authors.forename: Jennie
authors.initials: J
authors.lastname: Jing
authors.forename: Allen R
authors.initials: AR
authors.lastname: Nissenson
authors.forename: Istvan
authors.initials: I
authors.lastname: Mucsi
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Danovitch
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D001835:Body Weight; D003404:Creatinine / Q000097:blood; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D009765:Obesity / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D009929:Organ Size; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D055948:Sarcopenia / Q000150:complications / Q000401:mortality* / Q000473:pathology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D003404:Creatinine