Association of pre-transplant CT-derived perirenal fat measurements with post-transplant diabetes mellitus after kidney transplantation

Post-transplant diabetes mellitus (PTDM) is a common metabolic complication after kidney transplantation with important implications for patient and graft outcomes. We evaluated the association between pre-transplant computed tomography (CT)-derived adiposity measurements and the development of PTDM. We retrospectively studied adult kidney transplant recipients who underwent pre-transplant abdominal CT imaging. CT-derived adiposity measurements were obtained at standardized anatomical locations. Multivariable logistic regression models were constructed for each imaging parameter after adjustment for age, sex, and body mass index. Model discrimination was assessed using receiver operating characteristic analysis. Among all CT-derived adiposity measurements, right anterior perirenal fat thickness demonstrated the strongest independent association with PTDM (adjusted OR 1.07, 95% CI 1.03–1.12; P = 0.001). Right maximum perirenal fat thickness (adjusted OR 1.04, 95% CI 1.00–1.08; P = 0.028) and anterior subcutaneous fat thickness (adjusted OR 1.05, 95% CI 1.02–1.09; P = 0.005) were also independently associated with PTDM, whereas other CT-derived adiposity measurements were not. Pre-transplant right anterior perirenal fat thickness is independently associated with PTDM after kidney transplantation and improves prediction beyond conventional clinical risk factors. This simple CT-derived measurement may enhance pre-transplant metabolic risk assessment and warrants validation in prospective multicenter studies.