Franny Jongbloed

213 8 BENEFICIAL EFFECTS OF A PREOPERATIVE DIET Table 4B. (continued) Upstream regulator Description Z-score P- value Gene log ratio HSF1 Heat shock transcription factor 1 -0.251 4.50 E -02 -0.271 GATA3 GATA binding protein 3 -0.425 2.77 E -02 -0.360 KMT2D Lysine methyltransferase 2D -0.447 3.99 E -02 -0.251 EGR1 Early growth response 1 -0.600 4.68 E -02 0.130 TCF7L2 Transcription factor 7 like 2 -0.632 2.99 E -03 -0.329 PML Promyelocytic leukemia -0.785 4.28 E -04 -0.558 SMAD4 SMAD family member 4 -1.067 1.21 E -02 -0.361 STAT1 Signal transducer and activator of transcription 1 -1.534 1.23 E -02 -0.431 CREB1 cAMP responsive element binding protein 1 -1.591 1.97 E -02 0.295 IRF7 Interferon regulatory factor 7 -1.671 8.91 E -03 -0.374 BRCA1 BRCA1, DNA repair associated -1.719 1.24 E -04 0.228 POU2AF1 POU class 2 associating factor 1 -1.987 2.87 E -03 +0.287 PRDM1 PR/SET domain 1 -2.121 2.75 E -03 -0.429 SMARCB1 SWI/SNF related, matrix associated, actin dependent regulator of chromatin, subfamily b, member 1 -2.236 9.96 E -03 0.351 B. Differentially regulated upstream transcription factors (TFs) derived from the DET in the CCPR diet compared to the control group in kidney tissue of female donors, with their corresponding Z-score, P- value and gene log ratio. Significantly activated or inhibited TFs are depicted in bold. DISCUSSION Extensive animal studies have unequivocally established the beneficial effects of various short-termDR regimens on stress resistance, including renal and hepatic IRI, with the largest protection seen by fasting, calorie and protein restriction 10,12,14,17 . However, translation to clinical interventions has proven difficult because of concerns about the possible side effects of preoperative restrictive diets, lack of voluntary adherence and uncertainty regarding the DR strategy to be used 15 . Our randomized, controlled clinical trial demonstrates that five days of CCPR before live kidney donation is feasible, safe and significantly improves renal recovery in both donors and their recipients. These findings have wide clinical impact. DR was feasible as evidenced by the fact that all 15 donors adhered to the diet. Next to the self-reported adherence, we independently confirmed compliance to the diet based on significant weight loss and altered adherence markers prealbumin and retinol binding protein in the CCPR group. Levels of systemic postoperative inflammation markers were similar in both groups, which suggests that CCPR diet does not affect the postoperative