Lifestyle, Inflammation, and Vascular Calcification in Kidney Transplant Recipients: Perspectives on Long-Term Outcomes

After decades of pioneering, kidney transplantation is now established as preferred treatment for patients with end-stage renal disease. Yet, there is still need for optimizing long-term health state and downturn the burden of graft failure of kidney transplant recipients (KTR). In this thesis we describe our studies on potentially modifiable risk factors for graft failure and premature death, in the field of lifestyle, diet and exposure to toxic contaminants, which are underexplored areas in kidney transplantation. This approach unfolded potentially cost-effective risk management opportunities for outpatient KTR. Dietary interventional strategies based on individualized recommendations to increase fruit, vegetable, and fish intake in KTR may substantially alleviate the burden of premature death among outpatient KTR. Further investigation of the potential impact of policy measures and clinical guidance to decrease the exposure to cadmium and other toxic environmental contaminants is also warranted to decrease the burden of graft failure and function decline. The second part of this thesis supports the notion that non-traditional risk factors, such as chronic low-grade inflammation, persistent redox imbalance, and deregulated mineral and bone metabolism, may at least partly explain the excess risk of vascular disease in outpatient KTR. Further research on these non-traditional risk factors is also warranted as it may pave the way towards decreasing the long-standing burden of graft failure and premature death post-kidney transplantation.