Franny Jongbloed

203 8 BENEFICIAL EFFECTS OF A PREOPERATIVE DIET Table 1B. (continued) Parameter CCPR (n=15) Control (n=20) P- value CRP (mg/L) 2.7 (1.5-4.7) 2.1 (0.6-5.2) 0.205 Leukocytes (10 9 /L) 7.8 (6.8-9.7) 6.1 (5.5-8.2) 0.106 Type of donation (R/U/A) 3/3/9 4/12/4 0.083 Immunosuppressive therapy prior to transplantation (Yes/No) 4/11 5/15 1.000 Dialysis prior to transplantation (Yes/No) 6/9 9/11 0.687 Side of transplantation (Left/Right) 4/11 7/12 0.549 Values are depicted as median ± interquartile range. Significant values are depicted in bold. BMI = body mass index; CKD- EPI eGFR = estimated glomerular filtration rate using the CKD-EPI formula; CRP = C-reactive protein. Type of donation: R = related; U = unrelated; A = anonymous. HARP = hand-assisted retroperitoneal nephrectomy. # = both creatinine and hemoglobin levels of the living kidney donors were lower in the CCPR than the control group as a consequence of the gender differences in both groups. * = all kidney transplant recipients met the criteria for end-stage renal disease with a CKD-EPI eGFR <15 mL/min. Significance = P< 0.05. Compliance to the diet and surgical outcome All 15 donors in the CCPR group indicated they had adhered to the diet. This was in line with a number of independent parameters investigated. Serum levels of the adherence markers prealbumin (PAB), retinol binding protein (RBP), and the branched-chain amino acids valine and leucine were all significantly decreased after the CCPR diet (Figure S2). All donors in the CCPR group showed a decline in adherence markers, and they lost an average of 2.0 kilograms (range -4;0 kilograms) of body weight during the diet, which differed significantly from the slight average weight gain of 0.4 kilograms (range -4; +1 kilograms) observed in the control group ( P= 0.006). Perioperative outcomes did not significantly differ between the two arms in both donors and recipients (Table S2). Postoperative outcome Comparison of kidney donors receiving a control or CCPR diet Prior to the dietary intervention, serum creatinine levels significantly differed between donors in the CCPR and the control group (Figure 1A, POD-pre). One day before surgery ( i.e. at day 5 of dietary intervention), serum creatinine levels were similar (Figure 1A, POD-1). To assess postoperative changes in kidney function, a linear mixed-effects model analysis correlating with repeated follow-up measurements in each patient was used with random intercepts per patient. The donors on CCPR showed a significantly better clearance of absolute serum creatinine levels than the control group on postoperative day (POD) 2, POD3 and on postoperative month (POMo) 1, with a mean difference of 14,5 µmol/L (Table 2A). Absolute CKD-EPI eGFR (eGFR) values did not significantly differ in both groups. To correct for baseline interpatient variability, the relative values of both creatinine