Transplant Trial Watch

Protein and calorie restriction may improve outcomes in living kidney donors and kidney transplant recipients.

Jongbloed, F., et al.

https://www.ncbi.nlm.nih.gov/pubmed/32652516


Aims
The aim of this study was to examine the perioperative and postoperative effects of a five-day preoperative protein and caloric dietary restriction (PCR) diet in living kidney donors, their recipients and the transplanted renal grafts.

Interventions
Patients were randomly assigned to either the PCR group or the control group.

Participants
35 living kidney donors.

Outcomes
The main outcomes relating to the kidney donors were the assessment of kidney function and systemic inflammatory markers before and after kidney donation. The outcomes for the transplant recipients included urine production during surgery, the incidence of acute tubular necrosis (ATN), delayed graft function, slow graft function, biopsy-proven acute rejection, duration of hospital stay, the incidence of complications and kidney function before and after surgery.

Follow-up
6 months

CET Conclusions
This pilot, single-centre randomised controlled trial evaluated the effect of a preoperative protein and caloric dietary restriction (PCR) diet in living kidney donors on perioperative and postoperative outcomes in donors, recipients and the transplanted kidneys. No information was provided regarding the randomisation process and whether allocation concealment was employed. Thirty-five living kidney donors were randomised to one of two arms. The PCR diet consisted of 30% fewer calories and 80% fewer proteins. The control group continued their normal diet. All PCR patients declared that they had adhered to the diet, which was consistent with the compliance markers. There was no significant difference between groups for donor creatinine levels and eGFR from postoperative day 1 until 3 months. Donor relative creatinine clearance values that corrected for interpatient variability at baseline showed a significant difference for postoperative days 2 and 3, and at 1 month but no longer at 3 months. Donor serum urea levels were significantly lower in the PCR arm prior to surgery and on postoperative days 1 and 2. Recipients that received a kidney from a PCR donor experienced fewer episodes of biopsy-proven acute rejection (7% versus 40%). These preliminary data show that diet restrictions prior to donation is safe and feasible, and show promising effects that need to be confirmed in a larger trial.

Jadad score
1

Data analysis
Per protocol analysis

Allocation concealment
No

Trial registration
NTR3663 / NL3483

Funding source
Non-industry funded