Pretransplant Malnutrition Risk Components are Associated With Adverse Outcomes After Simultaneous Pancreas and Kidney and Solitary Pancreas Transplantation

BACKGROUND: Malnutrition is common among patients with end-organ disease. The impact of any criterion of malnutrition (weight loss, muscle depletion, fat depletion, inadequate oral intake, or reduced functionality) pretransplant among simultaneous pancreas-kidney (SPK) or solitary pancreas transplant (SPT) recipients is understudied. METHODS: In this single-center study, we included all SPK or SPT recipients who had pretransplant malnutrition assessed and were transplanted between 01/2016 and 04/2024. Recipients were categorized as at malnutrition risk (M+ve) if any one of the components of malnutrition was present and were compared with those without any component (M-ve). Outcomes of interest were length of stay, kidney delayed graft function (DGF), early readmission, cardiovascular events, acute rejection, uncensored graft failure, death-censored graft failure (DCGF), and death. RESULTS: A total of 234 SPK and 136 SPT recipients fulfilled the selection criteria. 44 (19%) of SPK recipients and 13 (10%) of SPT were MR+ve, with reduced functionality being the most common positive malnutrition component in both groups. Among SPK recipients, after adjustment for multiple variables, MR+ve was associated with early readmission (aOR: 1.79; 95% CI: 1.08-2.97; p = 0.02). Similarly, among SPT, MR+ve was associated with early readmission (aOR: 6.15; 95% CI: 2.43-15.5; p < 0.001); pancreas uncensored graft failure (aOR: 3.3; 95% CI: 1.14-9.58; p = 0.03) and pancreas DCGF (aOR: 4.45; 95% CI: 1.44-13.67; p = 0.009). CONCLUSION: The presence of any positive pretransplant malnutrition components is associated with worse posttransplant outcomes in pancreas transplant recipients. These findings help support informed decisions about transplant candidacy and nutrition optimization.