Franny Jongbloed

217 8 BENEFICIAL EFFECTS OF A PREOPERATIVE DIET Subjects Living kidney donors were approached by the trial coordinator (FJ) and then included during the work up for donation at the outpatient clinic of the department of Surgery of the Erasmus MC, University Medical Center Rotterdam, between May 2, 2014 and November 18, 2015. To be eligible for participation in the study, donors had to be between 18 and 70 years old, had to have a BMI ≥ 19 kg/m 2 , were not allowed to participate in another clinical trial in the 30 days prior to the day they were approached, and could have no known allergies to any of the ingredients in the diets. Figure S1. Randomization was performed using computer-generated lists as described previously 16 . No statistical power calculation for sample size was performed due to the pilot design of the study. In addition, since the detrimental effects of laparoscopic surgery on healthy living kidney donors was expected to be marginal, the inclusion of a substantially large number of donors was to be expected to reveal a significance based on a power calculation. With only a limited number of procedures per year, this inclusion rate would not have been feasible. Dietary intervention Patients in the CCPR group received a diet containing 30% fewer calories and 80% fewer protein. Dietary needs were calculated using the Harris–Benedict formula 36 as described previously 16 . The diet was given for five consecutive days and was initiated five days prior to surgery. The diet was based on a synthetic liquid diet as described previously 16 , and was supplemented with a limited number of low-protein and protein-free products (mainly fruits and vegetables) until the desired preset individual needs were met (Table S3). The calorie- and protein-restricted powder Scandishake® Mix shakes were kindly provided by Nutricia Advanced Medical Nutrition, The Netherlands. As described previously, the shake was provided as powder which was diluted with water. The powder consisted of 4% protein, 53% carbohydrate and 43% fat, respectively 16 (Table S3). The control group had no dietary restrictions and continued their normal diet. Surgical procedures Preoperative, perioperative, and postoperative anesthetic care concerning drug administration, ventilation and fluid regimens was carried out according to our local protocol for the kidney donors and kidney recipients. Donor kidneys were obtained via either a laparoscopic nephrectomy or a hand-assisted retroperitoneal nephrectomy (HARP) 37 . Kidney transplantation was performed via an open approach, and the kidney was positioned supra-inguinally on the external iliac artery and the external iliac vein. Additional informed consent was asked from the transplant recipients to obtain kidney