Introduction: No reports have shown an association between myosteatosis, the decline in the quality of skeletal muscle due to increased fat infiltration, and new-onset diabetes mellitus after transplantation (NODAT). We examine whether myosteatosis is a predictor of NODAT. Methods: The study included 334 patients who underwent renal transplantation between January 2006 and March 2021. We excluded 27 patients younger than 18 years, 85 patients with diabetic nephropathy, history of diabetes, or diabetic type diagnosed by preoperative oral glucose tolerance test, 3 patients with early renal function loss, and finally, 219 patients were examined. Presurgical non-contrast CT images were used to evaluate sarcopenia and myosteatosis. To evaluate sarcopenia, the psoas muscle index (PMI) in cm2/m2 was calculated by normalizing the total area of the psoas muscle at level L3 by the square of the patient’s height. To evaluate myosteatosis, the average total psoas density (ATPD) in HU was also calculated as an average of the entire left and right psoas muscle density. We investigated whether preoperative skeletal muscle depletion including sarcopenia and myosteatosis is a new risk factor in addition to the previously reported risk factors for NODAT. Results: Median recipient age and BMI were 45 years and 21.1 kg/m2, respectively, and 123 patients (56%) were male. The most common primary disease was chronic glomerulonephritis in 96 patients (43.8%), followed by IgA nephropathy in 40 patients (18.3%) and polycystic kidney disease in 16 patients (7.3%). Preoperative impaired glucose tolerance (IGT) was present in 58 patients (27%) and NODAT in 30 patients (14%), with median PMI and ATPD of 6 cm2/m2 and 41 HU, respectively. In univariate analysis of factors predicting NODAT, recipient age =45 years (p < 0.01), BMI =25 kg/m2 (p < 0.01), with IGT (p < 0.01), ATPD <41.9HU (p=0.01); in multivariate analysis, BMI =25 kg/m2 (p < 0.01), with IGT (p < 0.01) and ATPD <41.9 HU (p=0.03) were significant risk factors, respectively (Table 1). The incidence rates of NODAT were 3.7% with no risk factor, 10% with one risk factor, 33% with two risk factors, and 60% with three risk factors, respectively. The model effectively stratified patients with NODAT according to the number of risk factors (p < 0.01). Conclusions: Myosteatosis is a new risk factor predicting NODAT. SOURCE OF Funding: None
