Total parenteral nutrition in renal transplantation. Experimental observations

The nutritional support of the transplant recipient as a means of improving the allograft response after transplantation has not been investigated. This experimental study was designed in an attempt to define the role of malnutrition and total parenteral nutrition (TPN) on the rejection of canine renal allografts. Twenty-three mongrel dogs (18-23 kg) received kidney transplants from unrelated donors. All animals were minimally immunosuppressed with azathioprine (5.0-2.5 mg/K/day). Daily serum creatinines, biweekly complete blood counts, serum protein, and total iron binding capacity (TIBC) were determined. Postmortem examination was performed on all animals. Four groups of animals were compared: Group I (n = 5) served as a control and was maintained postoperatively on a regular balanced diet (RBD). Group II (n = 6) and Group IV (n = 6) were gradually malnourished prior to operation by diet leading to 12 to 22 per cent loss of weight, decreased albumin (2.0-2.6 mg/dl) and decreased TIBC (greater than 30%). After transplantation, Group II was maintained on 50 per cent RBD, and in Group IV, TPN was started two days prior to transplantation. The rejection times were 6.2 +/- 1.2, 9.5 +/- 3.5, 12.0 +/- 3.9, and 9.1 +/- 4.1 (mean +/- SD) days, respectively, for Group I through IV. TPN was not detrimental or beneficial to the allograft response of canine kidneys. Malnutrition, however, delayed significantly (P less than 0.005) the appearance of rejection after transplantation. Our findings appear to suggest that TPN could be safely used prior to and after transplantation if indicated, since it does not significantly alter the dog allogenic response following transplantation.