INFLUENCE OF IMMUNONUTRITION AND TRANSPLANT SUCCESS

虽然免疫抑制的改善增加了短期内 移植肾的存活率，前六次移植后的损失率 在过去的三十年里，月份的变化并不显著。这个 这项提案的长期目标是开发营养 补充剂将减少并发症并改善长时间 在免疫抑制最小的情况下人类同种异体移植物的持久存活。这个 这项研究的具体目的是进行前瞻性、随机化的 接受同种异体肾移植患者的临床试验 一种特殊移植饮食的耐受性、安全性和有效性 副刊。最近的动物研究表明，精氨酸和 同时含有omega 3和omega 9脂肪酸的菜籽油将 短程给药可显著延长同种异体移植物存活时间 环孢素A。一项正在进行的对移植后病情稳定的患者的研究 研究表明，饮食中补充精氨酸和菜籽油将 改善同种异体移植物的功能，通过降低血清肌酐来衡量 肌酐清除量的改善。这份副刊还包括 混合淋巴细胞培养的反应性降低，并导致 细胞因子的产生从Th1型反应转变为Th2型反应。那里 没有明显的不良反应 精氨酸和菜籽油的组合，最长可持续18天。建议数 研究将随机分配接受新的同种异体肾移植的患者 研究和控制组将接受相同的化学物质 免疫抑制。研究小组将开始服用补充剂 移植时的精氨酸和菜籽油。研究的主要终点 将包括排斥的发生率、排斥的类型和严重程度， 首次排斥反应时间、肾功能、患者和移植物存活率， 心血管事件的发生率、首发和持续时间 再住院、感染的发生率和类型、 慢性排斥，以及对血压的影响。预计 这些主要终点中的每一个都将受到积极影响， 营养免疫调节将成为人类免疫的重要组成部分 诱导实体器官长期耐受的治疗策略 移植。

While improvements in immunosuppression have increased the short term survival of renal allografts, the rate of loss after the first six months has changed insignificantly during the past three decades. The long-term objective of this proposal is to develop nutritional supplements that will decrease complications and allow improved long lasting allograft survival in man with minimal immunosuppression. The specific aim of this study is to perform a prospective, randomized clinical trial in patients receiving renal allografts to determine the tolerance, safety, and efficacy of a special transplant dietary supplement. Recent animal studies have shown that both arginine and canola oil, which contains both omega 3 and omega 9 fatty acids, will remarkedly prolong allograft survival when given with a short course of cyclosporine A. An ongoing study in stable posttransplant patients has shown that dietary supplementation with arginine and canola oil will improve allograft function as measured by a decrease in serum creatinine and an improvement in creatinine clearance. This supplement has also reduced responsiveness in mixed lymphocyte cultures and has caused a shift in the cytokine production from a Th1 to Th2 type response. There have been no significant adverse effects from administration of a combination of arginine and canola oil for up to 18 days. The proposed study will randomly assign patients receiving a new renal allograft into study and control groups which will receive the same chemical immunosuppression. The study group will begin dietary supplements of arginine and canola oil at transplant. Major endpoints of the study will include incidence of rejections, type and severity of rejection, time to first rejection, renal function, patient and graft survival, incidence of cardiovascular events, incidence and length of initial and rehospitalization, incidence and types of infections, incidence of chronic rejection, and effect on blood pressure. It is anticipated that each of these major endpoints will be influenced positively and that nutritional immune modulation will become an important component of therapeutic strategies to induce long-term tolerance in solid organ transplantation.