Posttransplant muscle mass measured by urinary creatinine excretion rate predicts long-term outcomes after liver transplantation

Long-term survival in orthotopic liver transplant (OLT) recipients remains impaired because of many contributing factors, including a low pretransplant muscle mass (or sarcopenia). However, influence of posttransplant muscle mass on survival is currently unknown. We hypothesized that posttransplant urinary creatinine excretion rate (CER), an established noninvasive marker of total body muscle mass, is associated with long-term survival after OLT. In a single-center cohort study of 382 adult OLT recipients, meanstandard deviation CER at 1year posttransplantation was 13.3 +/- 3.7mmol/24h in men and 9.4 +/- 2.6mmol/24h in women. During median follow-up for 9.8y (interquartile range 6.4-15.0y), 104 (27.2%) OLT recipients died and 44 (11.5%) developed graft failure. In Cox regression analyses, as continuous variable, low CER was associated with increased risk for mortality (HR=0.43, 95% CI: 0.26-0.71, P=.001) and graft failure (HR=0.42, 95% CI: 0.20-0.90, P=.03), independent of age, sex, and body surface area. Similarly, OLT recipients in the lowest tertile had an increased risk for mortality (HR=2.69; 95% CI: 1.47-4.91, P=.001) and graft failure (HR=2.77, 95% CI: 1.04-7.39, P=.04), compared to OLT recipients in the highest tertile. We conclude that 1 year posttransplant low total body muscle mass is associated with long-term risk of mortality and graft failure in OLT recipients.