Pediatric transplantation · 2026
Pre-Transplant CT Body Composition and Graft Outcomes in Pediatric Kidney Transplant Recipients: Revisiting the Adult Paradigm.
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Li Min, Li Xiaohua, Bai Zhaoyu, Luo Tingting, Xu Yumei, Deng Mengting, Wu Ruyi, Lu Bingfeng, Long Liling
Аннотация
BACKGROUND: Pre-transplant sarcopenia predicts adverse outcomes in adult kidney transplant recipients. Whether this association extends to pediatric populations-who exhibit distinct immunological profiles, growth dynamics, and adherence challenges-remains unknown. We investigated the relationship between computed tomography (CT)-quantified body composition and graft outcomes in children.
METHODS: Single-center retrospective cohort study of 46 pediatric kidney transplant recipients (age < 18 years) with preoperative T12-level CT imaging (2020-2024). Skeletal muscle area (SMA), intermuscular adipose tissue (IMAT), skeletal muscle density (SMD), and skeletal muscle index (SMI) were measured. The primary outcome was a composite endpoint of graft failure, defined as permanent return to dialysis (hemodialysis or peritoneal dialysis), re-transplantation, or death from any cause. Univariable Cox models were the primary analyses; multivariable models were exploratory given limited events (n = 12).
RESULTS: Transplant recipients had significantly lower SMA (61.05 vs. 65.54 cm2, p = 0.049), IMAT (0.80 vs. 1.72 cm2, p < 0.001), and BMI (17.30 vs. 20.41 kg/m2, p < 0.001). Over a median follow-up of 45 months, 12 patients experienced the primary outcome. Univariable Cox regression revealed no statistically significant association between the primary outcome and SMA (HR 0.99, 95% CI 0.96-1.03), IMAT (HR 1.18, 95% CI 0.73-1.90), SMD (HR 1.04, 95% CI 0.94-1.15), or SMI (HR 0.98, 95% CI 0.85-1.13). Multivariable models, conducted as exploratory sensitivity analyses, yielded consistent non-significant results.
CONCLUSION: No statistically significant association was detected between pre-transplant body composition parameters and adverse outcomes in this cohort of pediatric kidney transplant recipients. These preliminary findings suggest caution in directly extrapolating adult sarcopenia thresholds to children and highlight the need for larger, adequately powered pediatric studies to develop age-specific risk stratification tools.
METHODS: Single-center retrospective cohort study of 46 pediatric kidney transplant recipients (age < 18 years) with preoperative T12-level CT imaging (2020-2024). Skeletal muscle area (SMA), intermuscular adipose tissue (IMAT), skeletal muscle density (SMD), and skeletal muscle index (SMI) were measured. The primary outcome was a composite endpoint of graft failure, defined as permanent return to dialysis (hemodialysis or peritoneal dialysis), re-transplantation, or death from any cause. Univariable Cox models were the primary analyses; multivariable models were exploratory given limited events (n = 12).
RESULTS: Transplant recipients had significantly lower SMA (61.05 vs. 65.54 cm2, p = 0.049), IMAT (0.80 vs. 1.72 cm2, p < 0.001), and BMI (17.30 vs. 20.41 kg/m2, p < 0.001). Over a median follow-up of 45 months, 12 patients experienced the primary outcome. Univariable Cox regression revealed no statistically significant association between the primary outcome and SMA (HR 0.99, 95% CI 0.96-1.03), IMAT (HR 1.18, 95% CI 0.73-1.90), SMD (HR 1.04, 95% CI 0.94-1.15), or SMI (HR 0.98, 95% CI 0.85-1.13). Multivariable models, conducted as exploratory sensitivity analyses, yielded consistent non-significant results.
CONCLUSION: No statistically significant association was detected between pre-transplant body composition parameters and adverse outcomes in this cohort of pediatric kidney transplant recipients. These preliminary findings suggest caution in directly extrapolating adult sarcopenia thresholds to children and highlight the need for larger, adequately powered pediatric studies to develop age-specific risk stratification tools.