title: The influence of immunomodulatory diets on transplant success and complications.
abstract: BACKGROUND
  Animal studies have shown that dietary supplementation with arginine and lipids containing the omega-3 and omega-9 fatty acids prolong allograft survival in animals receiving a short course of low-dose cyclosporine. They also reduce cardiovascular complications and infections in humans.
  
  
  METHODS
  Adult renal transplant patients receiving standard immunosuppression were stratified according to gender, diabetic state, donor source (LD or CD), and first versus repeat transplant, and randomized to receive or not receive supplemental arginine and canola oil (containing both omega-3 and omega-9 fatty acids) twice daily. Patients were followed for a minimum of 3 years.
  
  
  RESULTS
  Seventy-six patients were randomized to the supplement group (S) and 71 patients to the control group (C). Intent-to-treat analysis revealed that S patients had fewer post-30 day first rejection episodes (5.4%) when compared with the C group (23.7%) (P=0.01) and fewer post-30 day episodes of calcineurin inhibitor (CNI) drug toxicity (9.2% vs. 35.3%, P=0.003). S patients developed new onset diabetes mellitus (NODM) less frequently by 3 years (2.3% vs. 14.5%, P=0.04), had fewer cardiac events (5.0% vs. 17.1%, P=0.05), and fewer episodes of sepsis (6.5% vs. 18.7%, P=0.05).
  
  
  CONCLUSIONS
  Dietary supplementation with L-arginine and canola oil is a safe, inexpensive, and unique treatment, which is associated with decreased rejection rates and CNI toxicity after the first month in renal transplant patients. Due to reductions in NODM and cardiac events, long-term benefits for patient survival may be particularly important.
authors.affiliation: Department of Surgery, Division of Transplantation, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0558, USA. jwesley.alexander@uc.edu
authors.forename: J Wesley
authors.initials: JW
authors.lastname: Alexander
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Metze
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McIntosh
authors.forename: Hope R
authors.initials: HR
authors.lastname: Goodman
authors.forename: M Roy
authors.initials: MR
authors.lastname: First
authors.forename: Rino
authors.initials: R
authors.lastname: Munda
authors.forename: Michael A
authors.initials: MA
authors.lastname: Cardi
authors.forename: Joe N
authors.initials: JN
authors.lastname: Austin
authors.forename: Sharad
authors.initials: S
authors.lastname: Goel
authors.forename: Shahzad
authors.initials: S
authors.lastname: Safdar
authors.forename: Norman
authors.initials: N
authors.lastname: Greenberg
authors.forename: Xiaowu
authors.initials: X
authors.lastname: Chen
authors.forename: E Steve
authors.initials: ES
authors.lastname: Woodle
mesh_terms: D001835:Body Weight; D065095:Calcineurin Inhibitors; D019587:Dietary Supplements; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000494:pharmacology; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology / Q000401:mortality; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000502:physiology
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D008055:Lipids; D009569:Nitric Oxide