Hyperlipidemia in Renal Transplant Recipients: Natural History and Response to Treatment

Ong, Colin S; Pollock, Carol; Caterson, Robyn J.; Mahony, J. F.; Waugh, David A.; Ibels, L. S.

doi:10.1097/00005792-199407000-00004

Cited by 65 publications

(37 citation statements)

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“…Hyperlipidemia is a common feature in renal trans plant recipients [11,12], Besides the role of transplant dyslipemia in the development of cardiovascular disease, there is increasing interest in the potential role of lipid abnormalities in the pathogenesis of CRAD. In the present study, patients with CRAD exhibited increased total, VLDL triglycerides and apo B levels, and showed a trend towards a more 'atherogenic' cholesterol profile (in creased total.…”

Section: Discussionmentioning

confidence: 99%

Increased Lipoproteins and Fibrinogen in Chronic Renal Allograft Dysfunction

Fernández‐Miranda¹,

Morales²,

Porres

et al. 1997

Am J Nephrol

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Chronic rejection – also called chronic renal allograft dysfunction (CRAD) – is the main cause of long-term loss of the transplanted kidney, but its pathogenesis is not well known. The aim of this study was to know if lipoproteins, fibrinogen, plasminogen activator inhibitor-1 (PAI-1) and platelet aggregation show more abnormalities in renal transplant patients with CRAD than in those with stable renal function. Sixty patients with renal allograft have been studied; 20 patients with CRAD and 40 controls matched for age, gender and time after transplantation. In a univariate analysis patients with CRAD had higher total serum triglycerides (214 ± 153 vs. 133 ± 39 mg/dl; p = 0.04) and very-low-density lipoprotein (VLDL) triglycerides (128 ± 116 vs. 59 ± 29 mg/dl; p = 0.04). Apolipoprotein B levels were also increased in patients with CRAD although this difference was only borderline significant (131 ± 58 vs. 98 ± 16 mg/dl; p = 0.05). Similarly, there was a trend toward increased total, VLDL, and low-density lipoprotein (LDL) cholesterol and reduced high-density lipoprotein (HDL) cholesterol in CRAD patients, but these differences did not reach statistical significance. Apolipoprotein A-1 and lipoprotein(a) levels were similar in both groups. Neither platelet aggregation nor PAI-1 levels differed between both groups. In contrast, fibrinogen was increased in patients with CRAD (373 ± 81 vs. 322 ± 62 mg/dl; p = 0.01). In a multivariate analysis triglycerides and fibrinogen were positively correlated to CRAD. These findings add further support to the hypothesis that lipid abnormalities may be involved in the pathophysiology of CRAD. In addition, this is the first report showing that fibrinogen levels are increased in patients with CRAD. Further studies are needed to evaluate a potential role of fibrinogen in the development of CRAD.

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Section: Discussionmentioning

confidence: 99%

Increased Lipoproteins and Fibrinogen in Chronic Renal Allograft Dysfunction

Fernández‐Miranda¹,

Morales²,

Porres

et al. 1997

Am J Nephrol

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“…1 Hyperlipidemia is recognized as a common complication after kidney and heart transplantation, 2,3 but the natural history of posttransplantation hyperlipidemia after orthotopic liver transplantation has been less well described. The initial report by Muñoz et al 4 showed that mean cholesterol levels increased after liver transplantation and appeared to be related to blood cyclosporine A levels.…”

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confidence: 99%

Serum cholesterol changes in long-term survivors of liver transplantation: A comparison between cyclosporine and tacrolimus therapy

et al. 1999

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The aim of this study was to compare the longterm effect of tacrolimus and cyclosporine therapies on serum cholesterol levels in liver transplant recipients. We retrospectively studied 127 consecutive adult liver transplant recipients who survived for at least 1 year after transplantation. Basal immunosuppression consisted of cyclosporine plus prednisone in 100 patients and tacrolimus plus prednisone in 27 patients. Hypercholesterolemia was defined as a fasting serum cholesterol level greater than 220 mg/dL. Mean follow-up was 39 months. No statistical significance was found between cyclosporine-and tacrolimus-treated patients regarding age, sex, diagnosis, and previous cholesterol levels; both groups were similar. Significantly more tacrolimus-treated patients were steroid free in the first and second year of follow-up (tacrolimus, 37% and 63%; cyclosporine, 13% and 32%, respectively; P F .01).In the third year of follow-up, this difference was not significant (77% v 56%). The overall incidence of hypercholesterolemia was 34.6% (44 patients). At the end of the study, hypercholesterolemia was found in 24 of 51 and 14 of 70 patients with and without steroids, respectively (P F .002). Also, mean cholesterol levels were 224 ؎ 70 and 191 ؎ 48 mg/dL before and after steroid withdrawal, respectively, P F .001. Hypercholesterolemia was found in 43.7% of the patients during cyclosporine plus prednisone therapy compared with 46.1% of the patients during tacrolimus plus prednisone therapy (P F .9). Greater mean cholesterol levels were found in the cyclosporine group, particularly in the second and third years of follow-up (P F .01). Hypercholesterolemia was found in 22% of the patients during cyclosporine monotherapy compared with 15% during tacrolimus monotherapy (P F .5). No differences were found in mean cholesterol levels during follow-up when both monotherapy groups were compared. In conclusion, a lower incidence of hypercholesterolemia was achieved in tacrolimus-treated patients, mainly when steroids were still part of the immunosuppressive treatment.

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“…Although some researchers did not observe a relation between CsA treatment and hyperlipidemia [5], many share the view that CsA increases lipid metabolism dysfunction affected by steroids [6,10]. The results gathered in the mid-80s indicate that both CsA and steroids are influencing factors in hyperlipidemia, and it was observed that CsA elimination resulted in an at least temporary decrease in cholesterol and triglyceride concentration despite ongoing steroid treatment [19].…”

Section: Discussionmentioning

confidence: 99%

“…Though many authors believe that the first two immunosuppressive agents are implicated in the development of hyperlipidemia, this subject is still controversial [5,6]. Values are presented as means from all samples of each parameter in the 1st and 2nd years.…”

Section: Introductionmentioning

confidence: 99%

Does Immunosuppressive Regimen Influence the Lipid Disturbances in Kidney Recipients?

Kisielnicka¹,

Zdrojewski²,

Wróblewska³

et al. 2000

Am J Nephrol

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Though it is said that some immunosuppressive agents are implicated in the development of hyperlipidemia in kidney recipients, this subject is still controversial. Main plasma lipid parameters, as well as apolipoproteins A1 and B were measured periodically in 39 kidney first cadaveric, nondiabetic recipients during 24 months of clinic follow-up after transplantation. Standard triple immunosuppressive therapy: prednisone + cyclosporine + azathioprine was administrated from the beginning. After the second year of kidney transplantation, a significant reduction refers to values of TC, LDL, apo A1 and apo B. In the group with antirejection - methylprednisolone therapy, and without it only TG in the 24th month and apo B in the 1st month were statistically lower in the latter group (both p < 0.05). In the multiple regression test, a linear coincidence was observed between apo A1, apo B and prednisone cumulative dosage after the 1st month, TG and cyclosporine in the 6th month and LDL and cyclosporine in the 12th month after transplantation. It appears that steroids had an impact on lipids directly after transplantation, while cyclosporine did so thereafter.

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Hyperlipidemia in Renal Transplant Recipients: Natural History and Response to Treatment

Cited by 65 publications

References 0 publications

Increased Lipoproteins and Fibrinogen in Chronic Renal Allograft Dysfunction

Increased Lipoproteins and Fibrinogen in Chronic Renal Allograft Dysfunction

Serum cholesterol changes in long-term survivors of liver transplantation: A comparison between cyclosporine and tacrolimus therapy

Does Immunosuppressive Regimen Influence the Lipid Disturbances in Kidney Recipients?

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