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Full Title: Effects of Omega-3 Fatty Acids on Organ Transplantation
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Objectives: To systematically assess the suggested beneficial effects of supplementation with omega-3 fatty acids on various transplant-related outcomes.
Data Sources: Electronic databases, such as MEDLINE®, were searched for potentially relevant studies. Experts in the individual areas of transplantation were contacted to identify other sources of data, including unpublished studies.
Review Methods: Data were recorded on study design, population demographics, the amount and type of omega-3 fatty acids consumed, and clinical outcomes. Features of methodological quality were also recorded.
Results: Major concerns for all 31 of the evaluated studies were their small sizes and methodological deficiencies. There was variability in the rigor with which endpoints were defined and measured. Important covariates (such as use of antihypertensive agents or the intensity of immunosuppression) were often poorly described or inconsistently applied, even when the study considered outcomes that may have been confounded by these factors. No consistent benefits of fish oil supplementation (used in all but one study) were observed for any outcome—with the exception of a modest benefit on triglycerides in kidney transplantation. Discordant results were noted among the studies measuring improvement in renal function. There were no clear patient- or study-related characteristics to account for the heterogeneity, and any functional improvement did not translate into other clinically important outcomes, such as improved graft survival.
A meta-analysis of rejection episodes in kidney transplantation found no statistically significant benefit on either early (<6 months post transplant) or late rejection with supplementation during followup of up to 1 year (relative risk = 0.91; 95% CI = 0.74, 1.10). A meta-analysis of graft survival in kidney transplantation found no significant benefit from fish oil supplementation (relative risk = 1.00; 95% CI = 0.96, 1.05). No clinically important interactions were observed between fish oil supplementation and the dose or trough-levels of cyclosporin A.
Conclusions: Although fish oil supplementation in organ transplant recipients is associated with an expected modest reduction in triglyceride concentrations, inconsistent benefits on renal function across studies may suggest a potential benefit in an as-yet-undefined subset of patients. Long-term studies are needed to determine whether benefits on renal function translate into improved renal outcomes. Similarly, long-term followup in recipients of heart transplants will be required to determine whether fish oil supplementation reduces the risk of post-transplant atherosclerosis. Applicability of the results to contemporary transplantation procedures is uncertain, as techniques have changed in the several years to a decade since most of the studies were performed.
Effects of Omega-3 Fatty Acids on Organ Transplantation
Evidence-based Practice Center: Tufts-New England Medical Center
Topic Nominator: Office of Dietary Supplements, National Institutes of Health
Current as of February 2005