BACKGROUND: Survival of kidney transplant recipients (KTR) is low compared with the general population. Low muscle mass and muscle strength may contribute to lower survival, but practical measures of muscle status suitable for routine care have not been evaluated for their association with long-term survival and their relation with each other in a large cohort of KTR.METHODS: Data of outpatient KTR ≥ 1 year post-transplantation, included in the TransplantLines Biobank and Cohort Study (ClinicalTrials.gov Identifier: NCT03272841), were used. Muscle mass was determined as appendicular skeletal muscle mass indexed for height 2 (ASMI) through bio-electrical impedance analysis (BIA), and by 24-h urinary creatinine excretion rate indexed for height 2 (CERI). Muscle strength was determined by hand grip strength indexed for height 2 (HGSI). Secondary analyses were performed using parameters not indexed for height 2. Cox proportional hazards models were used to investigate the associations between muscle mass and muscle strength and all-cause mortality, both in univariable and multivariable models with adjustment for potential confounders, including age, sex, body mass index (BMI), estimated glomerular filtration rate (eGFR) and proteinuria. RESULTS: We included 741 KTR (62% male, age 55 ± 13 years, BMI 27.3 ± 4.6 kg/m 2), of which 62 (8%) died during a median [interquartile range] follow-up of 3.0 [2.3-5.7] years. Compared with patients who survived, patients who died had similar ASMI (7.0 ± 1.0 vs. 7.0 ± 1.0 kg/m 2; P = 0.57), lower CERI (4.2 ± 1.1 vs. 3.5 ± 0.9 mmol/24 h/m 2; P < 0.001) and lower HGSI (12.6 ± 3.3 vs. 10.4 ± 2.8 kg/m 2; P < 0.001). We observed no association between ASMI and all-cause mortality (HR 0.93 per SD increase; 95% confidence interval [CI] [0.72, 1.19]; P = 0.54), whereas CERI and HGSI were significantly associated with mortality, independent of potential confounders (HR 0.57 per SD increase; 95% CI [0.44, 0.81]; P = 0.002 and HR 0.47 per SD increase; 95% CI [0.33, 0.68]; P < 0.001, respectively), and associations of CERI and HGSI with mortality remained independent of each other (HR 0.68 per SD increase; 95% CI [0.47, 0.98]; P = 0.04 and HR 0.53 per SD increase; 95% CI [0.36, 0.76]; P = 0.001, respectively). Similar associations were found for unindexed parameters. CONCLUSIONS: Higher muscle mass assessed by creatinine excretion rate and higher muscle strength assessed by hand grip strength are complementary in their association with lower risk of all-cause mortality in KTR. Muscle mass assessed by BIA is not associated with mortality. Routine assessment using both 24-h urine samples and hand grip strength is recommended, to potentially target interdisciplinary interventions for KTR at risk for poor survival to improve muscle status.
Op het congres van de Britisch Transplant Society en de Nederlandse Transplantatie Vereniging dat gehouden werd in Bournemouth, Engeland is deze bijgevoegde poster gepresenteerd. De poster beschrijft het onderzoek naar de inspanningstolerantie van mensen na een orgaantransplantatie op grote hoogte, tijdens de beklimming van de Kilimanjaro.
The SPRONG group, originating from the CoE KennisDC Logistiek, focuses on 'Low Impact in Lastmile Logistics' (LILS). The LILS group conducts practical research with local living labs and learning communities. There is potential for more collaboration and synergy for nationwide scaling of innovations, which is currently underutilized. LILS aims to make urban logistics more sustainable and facilitate necessary societal transitions. This involves expanding the monodisciplinary and regional scope of CoE KennisDC Logistiek to a multidisciplinary and supra-regional approach, incorporating expertise in spatial planning, mobility, data, circularity, AI, behavior, and energy. The research themes are:- Solutions in scarce space aiming for zero impact;- Influencing behavior of purchasers, recipients, and consumers;- Opportunities through digitalization.LILS seeks to increase its impact through research and education beyond its regions. Collaboration between BUas, HAN, HR, and HvA creates more critical mass. LILS activities are structured around four pillars:- Developing a joint research and innovation program in a roadmap;- Further integrating various knowledge domains on the research themes;- Deepening methodological approaches, enhancing collaboration between universities and partners in projects, and innovating education (LILS knowledge hub);- Establishing an organizational excellence program to improve research professionalism and quality.These pillars form the basis for initiating and executing challenging, externally funded multidisciplinary research projects. LILS is well-positioned in regions where innovations are implemented and has a strong national and international network and proven research experience.Societal issue:Last-mile logistics is crucial due to its visibility, small deliveries, high costs, and significant impact on emissions, traffic safety, and labor hours. Lastmile activities are predicted to grow a 20% growth in the next decade. Key drivers for change include climate agreements and energy transitions, urban planning focusing on livability, and evolving retail landscapes and consumer behavior. Solutions involve integrating logistics with spatial planning, influencing purchasing behavior, and leveraging digitalization for better data integration and communication. Digital twins and the Physical Internet concept can enhance efficiency through open systems, data sharing, asset sharing, standardization, collaboration protocols, and modular load units.Key partners: Buas, HR, HAN, HvAPartners: TNO, TU Delft, Gemeente Rotterdam, Hoger Onderwijs Drechtsteden, Significance, Metropolitan Hub System, evofenedex, Provincie Gelderland, Duurzaam Bereikbaar Heijendaal, Gemeente Alphen aan den Rijn, Radboud Universiteit, I&W - DMI, DHL, TLN, Noorderpoort, Fabrications, VUB, Smartwayz, RUG, Groene Metropoolregio.
