title: Abdominal lean muscle is associated with lower mortality among kidney waitlist candidates.
abstract: Morphometric assessments, such as muscle density and body fat distribution, have emerged as strong predictors of cardiovascular risk and postoperative morbidity and mortality. To date, no study has examined morphometric mortality risk prediction among kidney transplant (KT) candidates. KT candidates, waitlisted 2008-2009, were identified (n=96) and followed to the earliest of transplant, death, or administrative end of study. Morphometric measures, including abdominal adipose tissue, paraspinous and psoas muscle composition, and aortic calcification, were measured from CTs. Risk of waitlist mortality was examined using Cox proportional hazard regression. On adjusted analyses, radiologic measures remained independently and significantly associated with lower waitlist mortality; the addition of radiologic measures significantly improved model predictive ability over models containing traditional risk factors alone (net reclassification index: 0.56, 95% CI: 0.31-0.75). Higher psoas muscle attenuation (indicative of leaner muscle) was associated with decreased risk of death (aHR: 0.93, 95% CI: 0.91-0.96, P<.001), and for each unit increase in lean paraspinous volume, there was an associated 2% decreased risk for death (aHR: 0.98, 95% CI: 0.96-0.99, P=.03). Radiologic measures of lean muscle mass, such as psoas muscle attenuation and paraspinous lean volume, may improve waitlist mortality risk prediction and candidate selection.
authors.affiliation: Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Jayme E
authors.initials: JE
authors.lastname: Locke
authors.affiliation: Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: J Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.affiliation: Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Nair
authors.affiliation: Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: James G
authors.initials: JG
authors.lastname: Terry
authors.affiliation: Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Rhiannon D
authors.initials: RD
authors.lastname: Reed
authors.affiliation: Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Grant D
authors.initials: GD
authors.lastname: Smith
authors.affiliation: Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.affiliation: Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Vineeta
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
mesh_terms: D050153:Abdominal Fat; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D018482:Muscle, Skeletal; D011379:Prognosis; D016658:Psoas Muscles; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013851:Thinness; D014850:Waiting Lists / Q000401:mortality*
keywords: kidney transplantation; morphometric analysis; risk prediction; survival analysis; waitlist mortality