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Abstract
Kidney transplant recipients (KTR) are at increased risk of mortality, particularly from infectious diseases, due to lifelong immunosuppression. Although very long chain saturated fatty acids (VLSFA) have been identified as crucial for phagocytosis and clearance of infections, their association with mortality in immunocompromised patient groups has not been studied. In this prospective cohort study we included 680 outpatient KTR with a functional graft ≥1 year and 193 healthy controls. Plasma VLSFA (arachidonic acid (C20:0), behenic acid (C22:0) and lignoceric acid (C24:0)) were measured by gas chromatography coupled with a flame ionization detector. Cox regression analyses was used to prospectively study the associations of VLSFA with all-cause and cause-specific mortality. All studied VLSFA were significantly lower in KTR compared to healthy controls (all p < 0.001). During a median (interquartile range) follow-up of 5.6 (5.2–6.3) years, 146 (21%) KTR died, of which 41 (28%) died due to infectious diseases. In KTR, C22:0 was inversely associated with risk of all-cause mortality, with a HR (95% CI) per 1-SD-increment of 0.79 (0.64–0.99), independent of adjustment for potential confounders. All studied VLSFA were particularly strongly associated with mortality from infectious causes, with respective HRs for C20:0, C22:0 and C24:0 of 0.53 (0.35–0.82), 0.48 (0.30–0.75), and 0.51 (0.33–0.80), independent of potential confounders. VLSFA are inversely associated with infectious disease mortality in KTR after adjustment, including HDL-cholesterol. Further studies are needed to assess the effect of VLSFA-containing foods on the risk of infectious diseases in immunocompromised patient groups.
Highlights
Plasma levels of all three very long chain saturated fatty acids (VLSFA) were lower in Kidney transplant recipients (KTR) than in healthy controls (p < 0.001 for all)
As diabetes and the metabolic syndrome are highly prevalent in KTR compared to healthy controls (Table 1) [22,23] we suggest that the lower circulating VLSFA observed in KTR
Our study shows for the first time that circulating VLSFA are lower in KTR compared to healthy controls and that circulating VLSFA are inversely associated with infectious disease mortality
Summary
Kidney transplantation can be regarded as the “gold standard” therapy for patients with end-stage kidney disease. Kidney transplantation offers several benefits, such as superior survival, cost-effectiveness and improved quality of life [1,2,3]. The survival of kidney transplant recipients (KTR) is still significantly lower compared to age-matched controls in the general population, with infections being one of the major causes of this excessive mortality [4].
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