{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T03:20:54Z","timestamp":1784863254182,"version":"3.55.0"},"reference-count":99,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Sarcopenia, defined as the progressive loss of skeletal muscle mass and strength, is increasingly recognized as a significant concern in patients with chronic kidney disease (CKD) and particularly in kidney transplant recipients (KTx-ps). This review explores the complex interplay of pathophysiological mechanisms, prevalence, and management strategies of sarcopenia in the context of kidney transplantation. CKD contributes to sarcopenia through systemic inflammation, malnutrition, uremic toxin accumulation, and metabolic imbalances, all of which persist or are exacerbated after transplantation due to immunosuppressive therapies especially corticosteroids. Notably, the post-transplant period may introduce additional risks, such as altered body composition and reduced physical activity, further aggravating muscle wasting. Sarcopenia affects approximately 26% of KTx-ps, leading to adverse outcomes including decreased quality of life, increased risk of infection, frailty, delayed recovery, and graft loss. The diagnosis remains challenging due to variability in assessment tools and a lack of standardized criteria. Management strategies must be multifactorial, including personalized nutritional support, targeted physical activity, and, where appropriate, pharmacological interventions. Early identification through imaging and functional testing is critical, especially in older patients and those with prolonged dialysis vintage. Emerging therapies, such as myostatin inhibitors, offer promise but require further validation. Additionally, early steroid withdrawal may mitigate muscle loss without compromising graft survival in selected patients. This review underscores the need for heightened awareness and standardized protocols to identify and manage sarcopenia in kidney transplantation, ultimately improving long-term outcomes and patient-centered care.<\/jats:p>","DOI":"10.3390\/nu18091352","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T14:28:23Z","timestamp":1777040903000},"page":"1352","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sarcopenia in Kidney Transplantation: Bridging Pathophysiology to Patient-Centered Care"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1538-5225","authenticated-orcid":false,"given":"Anna","family":"Pisacreta","sequence":"first","affiliation":[{"name":"Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca\u2019 Granda Ospedale Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6196-5656","authenticated-orcid":false,"given":"Paolo","family":"Molinari","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca\u2019 Granda Ospedale Policlinico, 20122 Milan, Italy"},{"name":"Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5766-1297","authenticated-orcid":false,"given":"Lara","family":"Caldiroli","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca\u2019 Granda Ospedale Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margherita","family":"Di Naro","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca\u2019 Granda Ospedale Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2882-4226","authenticated-orcid":false,"given":"Francesco","family":"Pesce","sequence":"additional","affiliation":[{"name":"Division of Renal Medicine, Ospedale Isola Tiberina\u2014Gemelli Isola, 00186 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"De Amici","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca\u2019 Granda Ospedale Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Regalia","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca\u2019 Granda Ospedale Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Verdesca","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca\u2019 Granda Ospedale Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Malvica","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca\u2019 Granda Ospedale Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Grandaliano","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Surgery, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Nephrology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Castellano","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca\u2019 Granda Ospedale Policlinico, 20122 Milan, Italy"},{"name":"Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Alfieri","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca\u2019 Granda Ospedale Policlinico, 20122 Milan, Italy"},{"name":"Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s00223-013-9758-y","article-title":"Quality of life in sarcopenia and frailty","volume":"93","author":"Rizzoli","year":"2013","journal-title":"Calcif. 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