Effect of Dietary Fish Oil on Renal Function and Rejection in Cyclosporine-Treated Recipients of Renal Transplants

Abstract

Dietary fish oil exerts effects on renal hemodynamics and the immune response that may benefit renal-transplant recipients treated with cyclosporine. To evaluate this possibility, we studied the effect of fish oil on renal function, blood pressure, and the incidence of acute rejection episodes in cyclosporine-treated recipients of renal transplants. In a randomized, double-blind trial, 33 recipients of first cadaveric kidney transplants who were treated with cyclosporine and prednisolone ingested 6 g of fish oil daily during the first postoperative year (the fish-oil group), whereas another 33 renal-graft recipients treated with cyclosporine and prednisolone ingested 6 g of coconut oil daily for three months, after which time it was stopped (the control group). One year after transplantation, the fish-oil group had higher median values than the controls for glomerular filtration rate (53 vs. 40 ml per minute per 1.73 m2, P = 0.038) and effective renal plasma flow (214 vs. 178 ml per minute per 1.73 m2, P = 0.023) and lower mean arterial pressure (103 vs. 118 mm Hg, P = 0.0011). The cyclosporine doses in the two groups were similar. The cumulative number of rejection episodes was 20 in the controls, as compared with 8 in the fish-oil group (P = 0.029). One-year graft survival also tended to be better in the fish-oil group (97 vs. 84 percent, P = 0.097). The daily administration of 6 g of fish oil during the first postoperative year has a beneficial effect on renal hemodynamics and blood pressure in renal-transplant recipients treated with cyclosporine. Although the fish-oil group had significantly fewer rejection episodes than the control group, graft survival at one year was not significantly better in the fish-oil group., Cyclosporine has many side effects, the most important being nephrotoxicity1,2. The drug causes a dose-dependent, initially reversible decrease in the glomerular filtration rate and the effective renal plasma flow,3–5 often accompanied by an increase in blood pressure6 due to afferent arteriolar vasoconstriction7,8. The production of thromboxane A2,9 leukotriene C4, and leukotriene D410 is increased in cyclosporine-induced renal dysfunction. Thus, cyclosporine appears to disturb the balance in production between vasodilatory and vasoconstrictive eicosanoids. We previously demonstrated that in renal-transplant recipients with stable renal function, cyclosporine-induced renal dysfunction could be at least… © 1993, Massachusetts Medical Society. All rights reserved.