Higher Adherence to the Mediterranean diet is Associated with Lower Risk of Graft Failure in Renal Transplant Recipients

A.W. Gomes Neto, M.C.J. Osté, C.G. Sotomayor, E. van den Berg, R.O.B. Gans, S.J.L. Bakker, G.J. Navis

Thursday 15 march 2018

15:30 - 15:35h at Willem Burger Foyer

Categories: Clinical, Session (poster)

Parallel session: Poster session 3: Clinical

Background & Objectives

Despite improved short-term graft survival over recent years, long-term graft survival after renal transplantation has not significantly improved. Research in this field is traditionally dominated by immunological evaluation and treatment, however non-immunological causes including diet and lifestyle are often overlooked. In the general population the Mediterranean Diet is associated with better cardiovascular and renal outcomes. We investigated whether adherence to the Mediterranean Diet is associated with renal graft outcome in renal transplant recipients (RTR).

Methods

This prospective observational study was conducted in the Transplantlines Food and Nutrition Biobank Cohort Study of 707 stable adult RTR with a functioning graft for ≥ 1 year. Dietary intake was assessed using a validated Food Frequency Questionnaire of 177 food items. RTR missing dietary data were excluded, leaving 632 RTR eligible for analyses. Adherence to the Mediterranean Diet was calculated using the nine-point Mediterranean Diet Score (MDS) by Trichopoulou based on intake of legumes, nuts, soy products, cereals, fruit, vegetables, meat, dairy, fish, alcohol and fat. The association of MDS on graft failure, graft loss (graft failure or death) and renal function decline (doubling of serum creatinine or graft failure) was analyzed by Cox regression.

Results

 During follow-up of 5.2 [2.0-12.2] years, 105 (17%) RTR developed graft failure, 181 (29%) RTR developed graft loss and 119 (19%) RTR experienced renal function decline. MDS was inversely associated with all renal endpoints (graft failure: HR 0.70; 95%CI 0.52-0.94, graft loss: HR 0.76; 95%CI 0.64-0.90, renal function decline: HR 0.71; 95%CI 0.56-0.89 per 2-points increase in MDS), independent of adjustment for potential confounders including age, sex, BSA, primary renal disease, eGFR, 24-hr protein excretion, time after transplantation, HLA-mismatch, donor status and pre-emptive transplantation. Interaction analyses showed that the association of MDS with risk of graft failure (P=0.02), graft loss (P=0.006) and renal function decline (P=0.009) was affected by protein excretion, with greater benefit of MDS observed in RTR with higher protein excretion.

Conclusion

Adherence to the Mediterranean Diet is associated with better renal outcome in RTR. Our study suggests adopting a Mediterranean style diet may help preserve renal function, in particular in RTR with higher protein excretion.