The post-transplant reduction in tHcy was far smaller than expected with respect to renal function, and the post-transplant changes in the major biochemical determinants of tHcy contributed relatively little to explain the change in tHcy. Thus, the results suggest the post-transplant introduction of one or more factors that induce an increase in tHcy. Treatment with CS appears to be such a factor.

Abstract. Lipoprotein patterns were investigated before and after renal transplantation in a prospective study including 15 1 patients. Kidney graft losses during the first 6 months were associated with higher total cholesterol ( P = 0.03), LDL cholesterol (P=0.003) and LDL triglyceride levels ( P = O . O I ) before transplantation. Patients with serum cholesterol 26.9 mmol I-' before transplantation had more acute rejections (1.7 vs. 0.9), a worse graft function and more vascular intimal hyperplasia and glomerular mesangial changes in transplant biopsies at 6 months. Patients with serum creatinine levels exceeding I60 pmol I -' at 6 months had more severe lipid disorders already before transplantation.Serum creatinine at 6 months was influenced by the number of acute rejection episodes (P=O.OOOI) and the age of the donor (P=0.009) while the number of acute rejections was found to be related to pretransplant total cholesterol levels (P=0.0086) and the age of the recipient (P=0.025).In conclusion, pretransplant lipoprotein disturbances have an impact on the early outcome of renal transplantation. Since there is a progresssion of hyperlipidaemia following transplantation, this may have an influence also on the cardiovascular morbidity and late graft dysfunction.

Although atorvastatin reduced total and LDL cholesterol effectively it was not beneficial regarding the long-term outcomes of cardiovascular endpoints or survival. In contrast to other patient groups, patients with severe chronic kidney disease, especially those on dialysis, seem to derive limited benefit from this lower dose of atorvastatin.

Cardiovascular disease is a major hazard limiting the life expectancy of renal transplant recipients and the most frequent cause of late allograft loss. Patients with renal disease have usually been exposed for both traditional, and for them unique, risk factors over a prolonged period of time and may carry the burden of advanced atherosclerotic disease already at the time of transplantation. The observed survival benefit of transplantation is probably from elimination of the numerous uremia-related risk factors. However, immunosuppressive therapy and the chronic inflammatory state, together with genetic susceptibility and not infrequently impaired renal function, may bring about new potentially atherogenic conditions. Metabolic risk factors may jeopardize both patient and graft survival. Several observational studies provide evidence for the negative impact of preexisting metabolic abnormalities on long-term outcomes. Identification of modifiable cardiovascular risk factors may enable risk reduction also in renal transplant recipients. Results of ongoing intervention trials are awaited. The observed improvement of patient survival after renal transplantation during the past decade may reflect the increasing awareness and more optimal care of patients throughout the course of renal disease.

After a prolonged period of 24 months the extent of ultrafiltration need seems to be important for the outcome of the patients. Thereby those with higher need of ultrafiltration had worse prognosis. It seems important to motivate patients to reduce the extent of fluid intake between dialysis to prolong survival.