Franny Jongbloed

206 CHAPTER 8 Although the postoperative C-reactive protein (CRP) concentrations tended to be lower in the CCPR donors, no statistically significant difference was observed with control donors (Figure 2A). No differences in leukocyte numbers were seen (Figure 2B). Thus, the CCPR diet induced a specific nephroprotection postoperatively, but had no significant effect on systemic inflammatory markers. Comparison of kidney recipients receiving a control or CCPR diet Ideally, urine production inkidney transplant recipients starts directly after revascularization of the graft. In the CCPR group, urine production was delayed in 1/15 (7%) patients compared with 5/20 (25%) in the control group ( P= 0.135) (Table 3 and S2B). On POD1, a trend towards lower incidence of partial acute tubular necrosis (ATN) as indicated on a MAG3 scan, was found in the CCPR group (Table 3). As expected in a living kidney donor setting, delayed graft function (DGF) did not occur. Slow graft function (SGF) occurred significantly more often in the control group: 5/20 (25%) versus 0/15 (0%) ( P= 0.020). The incidence of biopsy-proven acute rejection (BPAR) was significantly higher in the control group than in the CCPR group: 8/20 (40%) versus 1/15 (7%) ( P= 0.013). Two kidney transplant recipients (both in the control group) developed severe acute rejection and subsequently underwent a transplant nephrectomy on days 6 and 12 after transplantation, respectively. Data from these patients were censored from the day of transplant removal. The postoperative immunosuppressive drug regimen was similar in both groups (tacrolimus (Tac), mycophenolate mofetil (MMF) and prednisolone), except for two patients in the control group who received belatacept instead of Tac. These two patients experienced BPAR and were switched from belatacept to Tac. The Tac pre-dose concentrations showed a trend towards higher concentrations in the CCPR group on POD3 ( P= 0.065) and POD5 ( P= 0.094). No significant differences were seen in the duration of hospital stay nor in the incidence or severity of the other postoperative complications during hospital stay (Table 3). Linear mixed-effects model analysis showed a significant improved absolute creatinine clearance in the CCPR recipients as from POD1 until POD5, with on average an improvement of 200 µmol/L per day in the CCPR group. No significant differences in absolute eGFR values were observed (Table 2B). Again, relative values of both creatinine and eGFR clearance showed significantly improved creatinine values in the CCPR group as fromPOD1 until POD5, correlating with a difference of 25% improved values compared to the control group (Table 2B). Assessment per time point showed no significant differences of absolute serum creatinine concentrations between groups throughout the postoperative follow-up (Figure 3A). Relative creatinine concentrations showed a trend towards improvement in the CCPR group on POD4