Background

Metabolic syndrome (MetS) is prevalent in patients with end-stage kidney disease, and kidney transplantation is expected to modify the metabolic status. However, whether changes in metabolic status at the time of transplantation affect recipient outcomes remains unclear.

Methods

We analyzed 4187 recipients registered in a nationwide prospective cohort from 2014 to 2020. MetS was defined as the presence of ≥3 components of the metabolic syndrome. Patients were classified based on the pre- and post-transplant MetS status: MetS-free, MetS-developed, MetS-recovered, and MetS-persistent. Study outcomes were occurrence of death-censored graft loss and a composite of cardiovascular events and death.

Results

Among recipients without pre-transplant MetS, 19.6% (419/2135) developed post-transplant MetS, and MetS disappeared in 38.7% (794/2052) of the recipients with pre-transplant MetS. Among the four groups, MetS-developed group showed the worst graft survival rate, and MetS-persistent group had a poorer composite event-free survival rate. Compared with MetS-free group, MetS-developed group was associated with an increased risk of graft loss (adjusted hazard ratio [aHR], 2.35; 95% confidence interval [CI], 1.17-4.98) and the risk of graft loss increased with increasing numbers of dysfunctional MetS components. MetS-persistent was associated with increased risks of cardiovascular events and death (aHR, 2.46; 95% CI, 1.12-5.63), but changes in the number of dysfunctional MetS components did not.

Conclusions

Kidney transplantation significantly alters the metabolic status. Newly developed MetS after transplantation was associated with an increased risk of graft loss, whereas persistent MetS exposure before and after transplantation was associated with increased risks cardiovascular events and patient survival.

PMID 37243323