Combined Calorie and Protein Restriction in Live Kidney Donors Improves Kidney Function in Both Donors and Transplant Recipients

F. Jongbloed, R.W.F. de Bruin, P. Beekhof, P. Wackers, D.A. Hesselink, H. van Steeg, J.H.J. Hoeijmakers, M.E.T. Dollé, J.N.M. IJzermans

Thursday 15 march 2018

12:05 - 12:15h at Willem Burger Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 3: Clinical

Introduction

Ischemia-reperfusion injury (IRI) negatively impacts on transplant outcome. Short-term dietary and protein restriction protects against IRI in mice. Previously, we showed that preoperative combined calorie and protein restriction (CCPR) is save in kidney donors and adherence to the diet was shown by compliance markers. Here, we investigated the effects of CCPR on outcome in live kidney donors and their recipients.

Methods

Thirty-five live kidney donors were randomized into either the CCPR (n=15) or control (n=20) group. The CCPR diet contained 30% fewer calories and 80% less protein for five days prior to donation; the control group had no restrictions. Effects of CCPR were assessed via metabolic parameters and postoperative kidney function of donors and recipients using percentage of serum creatinine compared to values preoperatively and percentage of acute tubular necrosis (ATN) determined by a MAG3 scan. Gene expression analysis was performed on biopsies taken before and after IRI.

Results

All patients complied to the CCPR, while no changes in metabolic parameters occurred due to the diet. From postoperative day (POD) 2 (P=0.011) up until 1 month postoperatively (P=0.036) kidney function of the donors was significantly better in the CCPR group. Kidney function of their recipients improved significantly from POD 4 (P=0.020) up until POD 14 (P=0.019). Partial ATN on POD 1 occurred in 1/15 of the CCPR donors and 6/20 in the control group (P=0.06). CCPR inhibited immune regulation pathways and anti-inflammatory regulator NFKB1A.

Conclusions

Five days of a preoperative calorie- and protein restriction diet in live kidney donors reduces the incidence of ATN, ameliorates kidney function in both donors and their recipients, and suppresses the immune response in the kidney on a transcriptional level. These results are the first to successfully translate the beneficial effects of short-term dietary restriction on postoperative outcome into the clinic.