Fruit and Vegetable Prescription Program for Food-Insecure Pediatric Kidney Transplant Recipients: A Pilot Study

Pediatric and young adult (PYA) kidney transplant recipients face substantial cardiometabolic risk related to long-term immunosuppression and are vulnerable to food insecurity (FI). Produce prescription programs may improve dietary quality and reduce FI, but their feasibility and impact in pediatric kidney transplant recipients are unknown.

We conducted a single-arm, prospective pilot study evaluating the feasibility, acceptability, and safety of a 6-month fruit and vegetable prescription program among food-insecure PYA kidney transplant recipients at a single U.S. pediatric center. Participants received monthly produce vouchers via restricted-use benefit cards redeemable for fruits and vegetables. Primary outcomes included feasibility (enrollment and voucher redemption), acceptability, and safety (hyperkalemia episodes and incidence of food-borne illness). Exploratory outcomes included changes in FI, self-reported dietary intake, and cardiometabolic measures.

Nineteen participants (median age 19 years, range 11-23) were enrolled, representing 100% of eligible patients approached; 18 were able to activate their card and were included in analyses. Voucher utilization was high, with 86% redeeming at least 50% of voucher funds. Acceptability was favorable: 89% of participants reported a highly positive experience and a maximal likelihood of recommending the program. No episodes of hyperkalemia occurred during the intervention. FI decreased from 53% at baseline to 22% at follow-up, though this difference was not statistically significant. Fruit and vegetable intake did not increase over the intervention. Serum bicarbonate increased following the intervention (24.97 vs. 22.07 mEq/L, p < 0.001), while BMI, blood pressure, and other electrolytes remained unchanged.

A produce prescription program was feasible, safe, and highly acceptable among PYA kidney transplant recipients with FI and warrants evaluation in larger studies.