Myosteatosis as a novel predictor of new-onset diabetes mellitus after kidney transplantation

Objectives: We evaluate the effect of myosteatosis on new-onset diabetes mellitus after kidney transplantation.Methods: Consecutive patients who had renal transplant between 2006 and 2021 were reviewed, and 219 patients were finally included. Psoas muscle index was used to evaluate sarcopenia and average total psoas density (calculated by computed tomography before surgery) for myosteatosis. We used Cox proportional regression analyses in investigation of whether skeletal muscle depletion before surgery inclusive of sarcopenia and myosteatosis is a new additional predictor of new-onset diabetes mellitus.Results: Median recipient age and body mass index were 45 years and 21.1 kg/m(2), respectively, and 123 patients (56%) were male. Preoperative impaired glucose tolerance was present in 58 patients (27%) and new-onset diabetes mellitus in 30 patients (14%), with median psoas muscle index of 6 cm(2)/m(2 )and average total psoas density of 41 Hounsfield Unit. In multivariate analysis, significant risk factors were body mass index =25 kg/m(2) (p < 0.01), impaired glucose tolerance (p < 0.01), and average total psoas density < 41.9 Hounsfield Unit (p = 0.03). New-onset diabetes mellitus had incidence rates of 3.7% without risk factors, 10% with a single risk factor, 33% with two, and 60% with three. Patients with new-onset diabetes mellitus were effectively stratified by the number of risk factors (p < 0.01).Conclusions: Myosteatosis could be a new risk factor used to predict new-onset diabetes mellitus.