Weight gain in long-term survivors of kidney or liver transplantation--another paradigm of sarcopenic obesity?
OBJECTIVE
Obesity in transplant recipients is a frequent phenomenon but data from body composition analyses in long-term survivors are limited. Body composition and energy metabolism were studied in patients after liver (LTX) and kidney (KTX) transplantation and patients with liver cirrhosis (LCI) or on chronic hemodialysis (HD) and compared to healthy controls.


METHODS
In 42 patients 50.0 mo (median; range 17.1-100.6) after LTX and 30 patients 93.0 mo (31.2-180.1) after KTX as wells as in LCI (n = 39) or HD (n = 10) patients mid-arm muscle and fat area, body cell mass, and phase angle (bioimpedance analysis), and resting energy expenditure (indirect calorimetry, REE(CALO)) were measured.


RESULTS
Obesity was more prevalent in LTX (17%) than LCI (3%) and in KTX (27%) than in HD (10%). In LTX and KTX, phase angle was higher than in end-stage disease (LTX 5.6° [4.1-7.2] versus LCI 4.4° [2.9-7.3], P < 0.001; KTX 5.9° [4.4-8.7] versus HD 4.3° [2.9-6.8]) but was lower in all patient groups than in controls (7.1°; 4.6-8.9; P < 0.001). In LCI and HD REE(CALO) was higher than predicted, while in LTX and KTX REE(CALO) was not different from predicted REE.


CONCLUSIONS
Despite excellent graft function, many long-term LTX or KTX survivors exhibit a phenotype of sarcopenic obesity with increased fat but low muscle mass. This abnormal body composition is observed despite normalization of the hypermetabolism found in chronic disease and cannot be explained by overeating. The role of appropriate nutrition and physiotherapy after transplantation merits further investigation.
IFB AdipositasErkrankungen, Forschungsbereich Bariatrische Chirurgie, Universitätsklinikum Leipzig, 04103 Leipzig, Germany.
Tatjana
T
Schütz
Heike
H
Hudjetz
Anne-Eve
AE
Roske
Cornelia
C
Katzorke
Georg
G
Kreymann
Klemens
K
Budde
Lutz
L
Fritsche
Hans-Hellmut
HH
Neumayer
Herbert
H
Lochs
Mathias
M
Plauth
D000273:Adipose Tissue / Q000378:metabolism; D000293:Adolescent; D000328:Adult; D000368:Aged; D001481:Basal Metabolism; D001823:Body Composition; D016022:Case-Control Studies; D058625:End Stage Liver Disease / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008099:Liver / Q000601:surgery; D008103:Liver Cirrhosis / Q000150:complications; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal; D009765:Obesity / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications; D015995:Prevalence; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy; D055948:Sarcopenia / Q000453:epidemiology / Q000209:etiology*; D017741:Survivors; D015430:Weight Gain; D055815:Young Adult