Franny Jongbloed

218 CHAPTER 8 biopsies. Biopsies of the renal cortex were taken at the end of the cold ischemia time (kidney off ice), just before implantation in the recipient was started using a punch biopsy with a diameter of 4 mm. Immunosuppressive therapy Kidney transplant recipients received the same initial immunosuppressive therapy, except for two patients in the control group who received betalacept (Bristol-Myers Squib, NYC, NY) instead of tacrolimus. The initial immunosuppressive treatment consisted of tacrolimus (Prograf®; Astellas Pharma, Leiden, The Netherlands), mycophenolate mofetil (MMF; CellCept®; Roche Pharmaceuticals, Woerden, The Netherlands) and prednisolone treatment. All patients received induction therapy with basiliximab (Simulect®, Novartis Pharma, Arnhem, theNetherlands).The doses, target whole blood or plasma concentrations, and phasing of immunosuppressive therapy has been described elsewhere in detail 38 . Outcome parameters Living kidney donors Before and after the dietary intervention, the following data were obtained from all donors: body weight, age, gender, length, and systolic blood pressure. The time point before dietary intervention was set at the moment of inclusion in the trial during a visit at the outpatient clinic. The time point of first blood withdrawal before start of the dietary intervention, POD-pre, varied from one day up to over a year. Therefore, we used POD-1 values after the dietary intervention as cutoff levels for the calculation of relative values. Before and at various time points after surgery, serum levels of parameters shown in Table S4 were determined. Since kidney function is dependent on various factors, including gender and age, relative values for serum creatinine and CKD-EPI eGFR were calculated. A schematic overview of the experimental timeline of the study is shown in Figure S2. Processing of the blood samples was done as described previously 16 . Kidney transplant recipients Before and after the dietary intervention, the following data were obtained from all transplant recipients: body weight, age, gender, length, and systolic blood pressure. Before and at various time points after surgery, serum values of parameters shown in Table S4 were determined. For assessment of standard laboratory values of transplant recipients without informed consent for the kidney biopsies, a non-WMO study addendum was handed in to the local METC of the Erasmus MC, Rotterdam, the Netherlands. In our center, all patients routinely undergo a mercaptoacetyltriglycine (MAG3) renal scintigraphy on postoperative day (POD) 1 to assess renal perfusion. In case of a gradual increase of activity in the parenchyma of the transplanted kidney without evidence of cortical excretion, acute