Hyperlipidemia After Renal Transplantation in Children

Abstract

\s=b\ A cross-sectional survey of 32 children who received renal allografts was undertaken to evaluate lipid profiles in a pediatric transplant population. Ages ranged from 8 to 18 years, and serum creatinine concentrations varied from 0.5 to 5.6 mg/100 ml (mean, 1.4 mg/100 ml). Fifty percent of patients showed an abnormal lipoprotein electrophoresis, and these were evenly divided between type II and type IV patterns. The data suggest that patients with type II pattern tend to be receiving higher doses of prednisone, and increasing levels of cholesterol and triglyceride are also associated with higher corticosteroid dosages. In contrast to the observations of others in dialysis patients, measurements of glucose metabolism such as fasting blood sugar and fasting insulin levels were not associated with lipid abnormalities in this population. Lipid abnormalities following renal transplantation in children are similar to those described in adults, and may contribute to morbidity in the years following successful renal transplantation.(Am J Dis Child 130: [951][952][953] 1976) Renal transplantation has now be¬ come an acceptable mode of therapy for chronic renal failure in children. The long-term effects of this therapy, however, are not well estab¬ lished. Hyperlipidemia, for example, has been described after renal trans¬ plantation in adults,1J and cardiovas-(Dr Lowrie). cular disease is the second leading cause of mortality in adult transplant recipients.' If abnormalities in lipid metabolism were also present in chil¬ dren, increased cardiovascular mor¬ bidity might well result. We therefore undertook a cross-sectional study of children who had received a renal transplant at this center, to evaluate lipid profiles in a pediatrie transplant population SUBJECTS AND METHODS Of 49 kidney transplants performed at Children's Hospital Medical Center, Bos¬ ton, between May 1971 and June 1974, thirty-two grafts were still functioning at the time of this study. Of these, 28 patients (15 boys and 13 girls) were evaluated.Those not included were two individuals with diabetes mellitus and two who failed to report for testing while in the fasting state. Ages ranged from 8 to 18 years (mean, 13.5 ± 3.6 SD) and patients had been followed up for from 2 to 39 months after transplantation (mean, 14.4 months).Peripheral venous blood was obtained after an overnight fast for determination of creatinine, cholesterol, and triglycéride levels and lipoprotein electrophoresis (LEP) in all patients. In addition, levels of fasting blood sugar (FBS) and plasma immunoreactive insulin (IRI) were mea¬ sured in 22 patients. Ideal body weight for height was determined for each patient from a standard pediatrie anthropométrie chart.1 Immunosuppressive therapy in¬ cluded prednisone in all patients. In addi¬ tion, 26 also received azathioprine, one received cyclophosphamide, and one re¬ ceived no additional immunosuppressive agent.Plasma glucose, creatinine, triglycéride, and cholesterol levels were determined by a device for automated chemical ...

Plasma Lipids, Lipoproteins and Apolipoproteins AI, All, and B in Renal Transplanted Children: What Risk for Accelerated Atherosclerosis?

“…A comparison with results obtained in two studies [3,5] of children with kidney graft was difficult, since these investigations did not refer to homogenous age groups similar to ours, and since the different types of hyperlip idemia were not considered separately.…”

Hyperlipidemia in long‐term survivors of pediatric renal transplantation

“…Compelling evidence exists for a relationship between steroid therapy and post‐transplant hyperlipidemia. A positive correlation between prednisone dose (daily or cumulative) and TC or TG has been reported in several studies of pediatric renal transplant recipients (1, 3, 5). In children and adults treated with CSA, withdrawal of prednisone results in a significant decline in serum cholesterol (7, 27, 28), although alternate day steroid therapy does not prevent post‐transplant hyperlipidemia (29).…”

Assessment of risk factors for cardiovasuclar disease in pediatric renal transplant patients

“…Most immunosuppressive regimens include induction and maintenance CS. There are various CVD‐related adverse effects associated with CS use, including hypertension and hyperlipidemia (2, 14, 15, 32). Prior to three yr ago, we used high‐dose intravenous CS in the induction phase followed by tapering doses of oral CS; currently the majority of our patients receive a completely SF immunosuppressive regimen.…”

“…Most recently, we have advocated complete CS avoidance in the majority of our TP recipients. One of the major reasons we advocated CS avoidance was the association between CS and hypertension and hyperlipidemia (2, 13–15). We observed significantly lower serum CHOL levels and a trend towards lower systolic and DBP in our SF patients, suggesting a potential protective advantage of steroid avoidance in this population.…”