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Open AccessArticle

Plasma Vitamin C and Cancer Mortality in Kidney Transplant Recipients

1
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
2
Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
3
Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, CP 8380453 Santiago, Chile
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(12), 2064; https://doi.org/10.3390/jcm8122064
Received: 15 October 2019 / Revised: 21 November 2019 / Accepted: 21 November 2019 / Published: 23 November 2019
(This article belongs to the Special Issue Recent Advances and Clinical Outcomes of Kidney Transplantation)
There is a changing trend in mortality causes in kidney transplant recipients (KTR), with a decline in deaths due to cardiovascular causes along with a relative increase in cancer mortality rates. Vitamin C, a well-known antioxidant with anti-inflammatory and immune system enhancement properties, could offer protection against cancer. We aimed to investigate the association of plasma vitamin C with long-term cancer mortality in a cohort of stable outpatient KTR without history of malignancies other than cured skin cancer. Primary and secondary endpoints were cancer and cardiovascular mortality, respectively. We included 598 KTR (mean age 51 ± 12 years old, 55% male). Mean (SD) plasma vitamin C was 44 ± 20 μmol/L. At a median follow-up of 7.0 (IQR, 6.2–7.5) years, 131 patients died, of which 24% deaths were due to cancer. In Cox proportional hazards regression analyses, vitamin C was inversely associated with cancer mortality (HR 0.50; 95%CI 0.34–0.74; P < 0.001), independent of potential confounders, including age, smoking status and immunosuppressive therapy. In secondary analyses, vitamin C was not associated with cardiovascular mortality (HR 1.16; 95%CI 0.83–1.62; P = 0.40). In conclusion, plasma vitamin C is inversely associated with cancer mortality risk in KTR. These findings underscore that relatively low circulating plasma vitamin C may be a meaningful as yet overlooked modifiable risk factor of cancer mortality in KTR.
Keywords: Kidney transplant; vitamin C; cancer mortality; oxidative stress. Kidney transplant; vitamin C; cancer mortality; oxidative stress.
MDPI and ACS Style

Gacitúa, T.A.; Sotomayor, C.G.; Groothof, D.; Eisenga, M.F.; Pol, R.A.; Borst, M.H.; Gans, R.O.; Berger, S.P.; Rodrigo, R.; Navis, G.J.; Bakker, S.J. Plasma Vitamin C and Cancer Mortality in Kidney Transplant Recipients. J. Clin. Med. 2019, 8, 2064.

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