Outcomes after kidney transplantation are continuously improving. However, even after a successful transplantation, patients remain at higher risk of cardiovascular diseases, cancer, infections, and premature death. An important factor associated with these risks is inflammation. In a healthy situation, inflammation helps activate immune cells and other cells, allowing pathogens to be tackled more quickly and promoting recovery. Once the danger has passed (for instance, when the pathogen has been eliminated, or the wound has healed), the body should turn off the inflammation. Inflammation is only necessary during periods of illness or recovery. Outside of these periods, inflammation mainly leads to problems and unwanted damage.
Unfortunately, in kidney transplant patients, we often observe a small but continuous level of inflammation, even when there is no necessity for it. This chronic, low-grade inflammation is partly due to immunological factors (targeted against the graft) that break through the immunosuppressive medication. Other factors that contribute to inflammation also play a role in kidney transplant patients.
This thesis of Daan Kremer highlights the scope of the problem of inflammation after kidney transplantation from various angles. Furthermore, it examines from different perspectives whether we can potentially address this inflammation by critically evaluating medication, nutrition, lifestyle, and supplementing iron and vitamin K. The effects of medication, nutrition, iron, and vitamin K still need further investigation. However, in my opinion, the research on lifestyle is sufficient to take action on rehabilitation after kidney transplantation: this should be included in the guidelines!
