Lipoprotein Levels and Post-Heparin Lipase Activities in Kidney Transplant Recipients: Ciclosporin- versus Non-Ciclosporin-Treated Patients

Abstract

Lipid and lipoprotein levels were measured in 118 clinically stable patients who had received a kidney transplant more than 1 year earlier. Seventy-one were treated with ciclosporin (CS), 47 were not. The CS group had significantly higher mean cholesterol (6.54 versus 6.00 mmol/l) and triglyceride (1.83 versus 1.34 mmol/l) concentrations than the non-CS group. LDL/HDL cholesterol ratios were similar in the two groups. The CS patients had higher creatinine and prednisolone doses and used β-blockers and loop diuretics more frequently. Multiple regression analysis did not show an independent correlation between lipid levels and treatment with CS. On the other hand, there was an independent correlation between cholesterol levels and treatment with loop diuretics, suggesting that such treatment contributes to the higher cholesterol levels in kidney transplant recipients. The diabetics had a more favorable lipoprotein profile than the nondiabetics, especially in triglycerides and HDL cholesterol levels. The marked difference in triglyceride levels between the treatment groups prompted us to evaluate the lipoprotein lipase and hepatic lipase activities in 20 hyperlipidemic, nondiabetic patients. Both enzyme activities were moderately reduced with no difference between the treatment groups, suggesting that factors other than CS interfere with the lipase activities in kidney transplant recipients.

Hyperlipidemia after Renal Transplantation: Treatment with Gemfibrozil

“…Gemfibrozil reduces very-low-density lipoprotein (VLDL) synthesis and increases lipoprotein lipase activity, thereby descreases the levels of TG and LDL-C, and in creases the level of HDL-C [29,30], In this context, reduced lipoprotein lipase activity has been demonstrated after re nal transplantation [31]. We have shown that gemfibrozil was effective in achieving sustained reductions in TC, TG, and LDL-C, despite concomittant immunosuppression.…”

“…Furthermore, although there was a tendency for hyper lipidemia to improve with time after renal transplantation, as shown in the serial comparative study, gemfibroziltreated patients demonstrated more favorable lipid profiles compared to untreated controls after being followed for more than 2 years. The lack of improvement in HDL-C might be related to the gemfibrozil dosage, the concomitant administration of drugs that altered lipid metabolism, and the reduced lipoprotein lipase activity after renal transplan tation [31]. Our results differed from those of a previous study on 12 renal allograft recipients, which demonstrated similar reductions in TG and TC /H D L ratio, but no signifi cant change in the levels of TC, HDL, and LDL, after a treatment duration of 6 months [22].…”

Plasma Concentration Profiles of Simvastatin 3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Inhibitory Activity in Kidney Transplant Recipients with and without Ciclosporin

“…High prevalence of hyperlipidemia, particularly hyper cholesterolemia, was recognized early in the history of renal transplantation [1], This has been considered to contribute to the high morbidity and mortality from atherosclerotic disease in this patient group [2,3], There is evidence that the addition of ciclosporin (CS) to the immunosuppressive protocol has increased the tendency to hyperlipidemia [4,5], The necessity of finding an acceptable lipid-lowering treatment for CS-treated patients is getting more impera tive. The 3-hydroxy-3-methylgiutaryl-coenzyme A (HMGCoA) reductase inhibitors (Rls) seem to be suitable, gener In many of the above-mentioned cases, CS was sus pected of interfering with the elimination of lovastatin.…”

HDL Subtractions Distribution in Renal Transplant Recipients: Lack of Evidence of a Reduction of HDL₂ Particles

“…Immunosuppressive treatment (in particular prednisone and cyclosporine) might be implicated in the develop ment of lipoprotein alterations. However cyclosporine seems to mainly affect plasma CHO and LDLC and TG levels, but not HDLC concentrations [31][32][33], whereas prednisone therapy should also elevate HDL levels, and the response of lipids to exposure of corticosteroids was found to be time-related [34-36], The time since trans plantation. found to be significantly associated with HDLC levels in the present study, includes the time of exposure to immunosuppressive drugs.…”