Priority Research Paper Volume 12, Issue 13 pp 12441—12467

Protein and calorie restriction may improve outcomes in living kidney donors and kidney transplant recipients

Franny Jongbloed1,2, , Ron W.F. de Bruin1, , Harry Van Steeg2,3, , Piet Beekhof2, , Paul Wackers2, , Dennis A. Hesselink4, , Jan H.J. Hoeijmakers5, , Martijn E.T. Dollé2, , Jan N.M. IJzermans1, ,

  • 1 Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  • 2 Laboratory of Health Protection Research, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
  • 3 Department of Toxicogenetics, Leiden University Medical Center, Leiden, The Netherlands
  • 4 Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  • 5 Department of Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

Received: February 25, 2020       Accepted: June 16, 2020       Published: July 11, 2020
How to Cite

Copyright © 2020 Jongbloed et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Previously, we and others showed that dietary restriction protects against renal ischemia-reperfusion injury in animals. However, clinical translation of preoperative diets is scarce, and in the setting of kidney transplantation these data are lacking. In this pilot study, we investigated the effects of five days of a preoperative protein and caloric dietary restriction (PCR) diet in living kidney donors on the perioperative effects in donors, recipients and transplanted kidneys. Thirty-five kidney donors were randomized into either the PCR, 30% calorie and 80% protein reduction, or control group without restrictions. Adherence to the diet and kidney function in donors and their kidney recipients were analyzed. Perioperative kidney biopsies were taken in a selected group of transplanted kidneys for gene expression analysis. All donors adhered to the diet. From postoperative day 2 up until month 1, kidney function of donors was significantly better in the PCR-group. PCR-donor kidney recipients showed significantly improved kidney function and lower incidence of slow graft function and acute rejection. PCR inhibited cellular immune response pathways and activated stress-resistance signaling. These observations are the first to show that preoperative dietary restriction induces postoperative recovery benefits in humans and may be beneficial in clinical settings involving ischemia-reperfusion injury.


ATN: acute tubular necrosis; BMI: body mass index; BPAR: biopsy-proven acute rejection; PCR: protein and caloric dietary restriction; CKD-EPI eGFR: chronic kidney disease-epidemiology collaboration estimated glomerular filtration rate; DER: daily energy requirements; DGF: delayed graft function; DR: dietary restriction; ESRD: end-stage renal disease; IRI: ischemia-reperfusion injury; KT: kidney transplantation; MAG3: mercaptoacetyltriglycine (renal scintigraphy); PAB: prealbumin; PCA: principal component analysis; POD: postoperative day; POMo: postoperative month; RBP: retinol binding protein; ROS: reactive oxygen species; SGF: slow graft function; VAS: visual analog score.