Dietary Management for Dyslipidemia in Liver Transplant Recipients

Abstract

Background: Dyslipidemia occurs in approximately 70% of all liver transplant (LT) recipients, and no prior control studies have demonstrated any dietary intervention to change it. Aim: To analyze the effects of a dietary intervention on the lipid profile of dyslipidemic LT recipients. Methods: All LT recipients with dyslipidemia on clinical follow-up were enrolled. Anthropometric evaluation, food history, body composition (bioimpedance) and assessment of basal metabolism through indirect calorimetry were performed. Patients met with a dietitian and an individualized diet based on estimate of basal metabolism and consisting of 25% of the total energy value in total fat and <200 mg/day of cholesterol was prescribed. Total cholesterol (TC), HDL-cholesterol (HDL), LDL-cholesterol (LDL), triglycerides (TG) and anthropometric measures were measured at baseline and six months after intervention. Results: Fifty-thee out of 56 patients concluded follow-up; age was 59±10 years; 29 were men (51.8%). The analysis pre- and post-intervention were, respectively: TC 238.9±30 and 165.1±35, p<0.001; LDL 154±33 and 90±29, p<0.001; and TG 168 (IQR=51-200) and 137 (IQR=94-177), p=<0.001. They were all modified at six months following intervention. At baseline, none of the patients had normal TC, and only 12 (22.7%) had optimal/near optimal LDL. Following dietary intervention, 45 patients (84.9%) reached normal TC and 50 (94.4%) had optimal/near optimal LDL. HDL and anthropometric measures were not modified. Conclusions: Dietary counseling with prescription of individualized diet based on estimate of basal metabolism through indirect calorimetry was able to manage dyslipidemia in most LT recipients; so, all dyslipidemic LT recipients must be enrolled on a dietary program.

Comparison of Lipid Profiles Between Pediatric Living- and Deceased-Donor Liver Recipients

“…Pinto et al evaluated the effect of diet on reducing lipid pro les in 53 patients with liver transplant, and their results showed that post-transplant TC, LDL and TG pro les were signi cantly decreased by dietary intervention. The mean of each of these pro les was 160, 84.2 and 150 mg/dL for boys and 169, 95.8 and 123.5 mg/dL for girls, respectively (10).…”

“…Therefore, it is essential to consider recommendations for managing lipid levels in liver transplant recipients, including considering the risk factors of CVD and the effects of immunosuppressive agents. (10) While research on post liver transplant dyslipidemia has focused on patient factors and immunosuppressive regimens, the role of liver donors in the development or prevention of this complication are not investigate properly.…”

Dyslipidemia in Transplant Patients: Which Therapy?

“…Multiple factors contribute to lipid alterations, such as genetic predisposition [ 44 , 45 , 46 ], dietary habits [ 51 ], and age; however, the main effect is due to immunosuppressants, which have shown intrinsic pharmacodynamic properties to cause dyslipidemia and hyperglycemia [ 52 , 53 ]. In line with these findings, serum total cholesterol concentration is higher in the first 3–6 months after transplantation, when immunosuppressants are administered at higher doses [ 54 ].…”

Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors Use for Atherogenic Dyslipidemia in Solid Organ Transplant Patients

“…In particular, atherogenic dyslipidemia is present in about 80% of kidney transplant recipients [ 4 ], 80% of heart transplant recipients [ 5 ], and 70% of liver transplant recipients [ 57 ], compared to about 30–40% of the general population [ 58 , 59 ]. These variations are due to multiple factors, such as genetic [ 60 , 61 , 62 ] and lifestyle [ 63 , 64 ] factors; however, the main role is probably played by immunosuppressants, which exert pharmacodynamic and pharmacokinetic interferences on lipid and glycemic metabolism [ 11 , 65 ]: in fact, in the first months after transplantation, during which immunosuppressants are administered at a higher dose, higher total cholesterol serum levels were found [ 66 ].…”