title: The association between marine n-3 polyunsaturated fatty acid levels and survival after renal transplantation.
abstract: OBJECTIVE
  Several studies have reported beneficial cardiovascular effects of marine n-3 polyunsaturated fatty acids. To date, no large studies have investigated the potential benefits of marine n-3 polyunsaturated fatty acids in recipients of renal transplants.
  
  
  METHODS
  In this observational cohort study of 1990 Norwegian recipients of renal transplants transplanted between 1999 and 2011, associations between marine n-3 polyunsaturated fatty acid levels and mortality were investigated by stratified analysis and multivariable Cox proportional hazard regression analysis adjusting for traditional and transplant-specific mortality risk factors. Marine n-3 polyunsaturated fatty acid levels in plasma phospholipids were measured by gas chromatography in a stable phase 10 weeks after transplantation.
  
  
  RESULTS
  There were 406 deaths (20.4%) during a median follow-up period of 6.8 years. Mortality rates were lower in patients with high marine n-3 polyunsaturated fatty acid levels (≥7.95 weight percentage) compared with low levels (<7.95 weight percentage) for all age categories (pooled mortality rate ratio estimate, 0.69; 95% confidence interval, 0.57 to 0.85). When divided into quartiles according to marine n-3 polyunsaturated fatty acid levels, patients in the upper quartile compared with the lower quartile had a 56% lower risk of death (adjusted hazard ratio, 0.44; 95% confidence interval, 0.26 to 0.75) using multivariable Cox proportional hazard regression analysis. There was a lower hazard ratio for death from cardiovascular disease with high levels of marine n-3 polyunsaturated fatty acid and a lower hazard ratio for death from infectious disease with high levels of the marine n-3 polyunsaturated fatty acid eicosapentaenoic acid, whereas there was no association between total or individual marine n-3 polyunsaturated fatty acid levels and cancer mortality.
  
  
  CONCLUSIONS
  Higher plasma phospholipid marine n-3 polyunsaturated fatty acid levels were independently associated with better patient survival.
authors.affiliation: Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway; ivaeid@ous-hf.no.
authors.forename: Ivar A
authors.initials: IA
authors.lastname: Eide
authors.affiliation: Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway; Metabolic and Renal Research Group, University of Tromsø The Arctic University of Norway, Tromsø, Norway;
authors.forename: Trond
authors.initials: T
authors.lastname: Jenssen
authors.affiliation: Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, The University of Oslo, Oslo, Norway;
authors.forename: Anders
authors.initials: A
authors.lastname: Hartmann
authors.affiliation: Department of Biostatistics, Epidemiology and Health Care Economics, Oslo University Hospital, Oslo, Norway;
authors.forename: Lien M
authors.initials: LM
authors.lastname: Diep
authors.affiliation: Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway;
authors.forename: Dag O
authors.initials: DO
authors.lastname: Dahle
authors.affiliation: Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway; The Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, Oslo, Norway;
authors.forename: Anna V
authors.initials: AV
authors.lastname: Reisæter
authors.affiliation: Department of Medical Biochemistry, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway; and.
authors.forename: Kristian S
authors.initials: KS
authors.lastname: Bjerve
authors.affiliation: Departments of Nephrology and.
authors.forename: Jeppe H
authors.initials: JH
authors.lastname: Christensen
authors.affiliation: Cardiology, Aalborg University Hospital, Aalborg, Denmark; and.
authors.forename: Erik B
authors.initials: EB
authors.lastname: Schmidt
authors.affiliation: Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: My
authors.initials: M
authors.lastname: Svensson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002423:Cause of Death; D002849:Chromatography, Gas; D015331:Cohort Studies; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage / Q000097:blood*; D005260:Female; D005399:Fishes; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009664:Norway; D016016:Proportional Hazards Models; D065840:Protective Factors; D012042:Registries; D012307:Risk Factors; D017747:Seafood; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015525:Fatty Acids, Omega-3
keywords: mortality; survival; transplantation; ω3 fatty acids