{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T06:00:22Z","timestamp":1790229622438,"version":"4.1.0"},"reference-count":106,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["Transpl. Int."],"abstract":"<jats:p>Although kidney transplantation (KTx) remains the optimal therapy for end-stage kidney disease, long-term graft survival and patient outcomes continue to be limited by cardiometabolic complications and chronic allograft dysfunction. Nutritional management has evolved from supportive care to a core component of post-transplant follow-up. The early post-transplant phase is marked by catabolism, high-dose immunosuppression, and metabolic instability, leading to increased protein requirements but also potential susceptibility to hyperfiltration injury. In the stable post-transplant phase, a moderate protein intake similar to that recommended for chronic kidney disease (CKD) may support graft longevity, although evidence in kidney transplant recipients (KTRs) remains limited and inconsistent. Plant-forward dietary models, including Mediterranean and DASH patterns, consistently improve cardiometabolic risk, inflammation, oxidative stress, and dietary acid load, with potential benefits for graft outcomes. Predominantly plant-based diets may further reduce uremic toxin generation and improve mineral metabolism, though careful monitoring for micronutrient deficiencies is required. Low-protein approaches, such as PLADO, remain largely theoretical in transplant populations, while ketogenic or very low-carbohydrate diets raise concerns regarding acid\u2013base balance, renal hemodynamics, and long-term tolerability. Overall, personalised nutritional strategies tailored to graft function, immunosuppression, and metabolic profile are essential to optimise long-term transplant health.<\/jats:p>","DOI":"10.3389\/ti.2026.16322","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:10:05Z","timestamp":1790226605000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Nutritional strategies in kidney transplantation: optimising outcomes beyond surgery"],"prefix":"10.3389","volume":"39","author":[{"given":"Lara","family":"Caldiroli","sequence":"first","affiliation":[{"name":"Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca\u2019 Granda Ospedale Policlinico","place":["Milan, Italy"]},{"name":"Department of Clinical Sciences and Community Health, University of Milan","place":["Milan, 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