Kidney transplant:

Hello,
I underwent a double nephrectomy and received a kidney transplant almost eleven years ago. I have been on prednisone (5mg/day) and tacrolimus since that time.

  1. Would the recommendation for 1.6 gm/kg protein be ok for kidney transplant recipients?

  2. Is there any changes to training that would be indicated due to taking the prednisone for decade(s). (While most transplant patients taper off prednisone, I developed post transplant lymphoma disorder about a year after transplant and had a rejection episode that led to this current immunosuppressant combination.)

I am in my 18th week of using the Hypertrophy I template.

Thank you so much!

[quote=“Eldon, post:1, topic:13037, username:Eldon”]
Hello,
I underwent a double nephrectomy and received a kidney transplant almost eleven years ago. I have been on prednisone (5mg/day) and tacrolimus since that time.

  1. Would the recommendation for 1.6 gm/kg protein be ok for kidney transplant recipients?

[/quote]​

Unfortunately I don’t have specific expertise in the context of post-transplant nutrition. I expect that this would be fine in most situations, but I cannot speak to every individual situation. I found one paper discussing the topic, which recommends:

The focus should be on optimizing nutrition for the patient in the early period after transplantation and adequate nutrition should be provided. Even if the patient is obese in the early period after transplantation, weight loss should not be the goal. Therefore, 30-35 kcal/kg/d for dietary energy and 1.2-2.0 g/kg/d for protein are recommended in the early period. In the long term after transplantation, dietary recommendations should not differ significantly from the general population, unless there is another underlying problem. Long-term energy recommendations offer a wide range of 23-35 kcal/kg/d and should aim to maintain a healthy body weight[9]. National Kidney Foundation 2020 Guidelines recommend 25-35 kcal/kg/d energy intake for post transplantation patients[22]. Protein recommendations in the long term after transplantation vary depending on the diabetes status. While the protein recommendation for a patient without diabetes is 0.6-0.8 g/kg/d, protein recommendation for a patient with diabetes is 0.8-0.9 g/kg/d[9]. The reason why the protein recommendation is high immediately after transplantation is the ability to reverse the negative nitrogen balance[23].

They do note that “In the long term after transplantation, dietary recommendations should not differ significantly from the general population, unless there is another underlying problem.”, which makes sense to me. It is not clear on what basis the subsequent long-term recommendations for lower thresholds came from, outside of typical RDA values. Overall I suspect the 1.2-1.6 g/kg range would be reasonable, particularly given that the person is active and training/meeting physical activity guidelines, but I can’t make individualized recommendations here.

Sorry to hear about those complications, but I’m glad they turned out to be treatable/manageable. I would not make any specific changes just because you are on prednisone, but rather would work through the same trial-and-error approach as I would with anyone else to figure out a training setup that fits with their goals and generates the desired response.

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I know you guys are incredibly busy, so thank you so very much for taking the time to share your expertise Austin. It is appreciated more than you can know.

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