Influence of Immunosuppressive Therapy on Lipoprotein(a) and Other Lipoproteins following Renal Transplantation

Brown, John H.; Murphy, B G; Douglas, A F; Short, Colin D.; Bhatnagar, Deepak; Mackness, Mike; Hunt, Linda; Doherty, C C; Durrington, Paul N.

doi:10.1159/000189549

Cited by 44 publications

(15 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our data are consistent with other prospective studies that have shown decreases of Lp(a) after transplantation several months to years post-transplant [24,25,26,27]. Prevalence of Lp(a) >25 mg/dl was 31–37% after 2–10 months post-transplant [28, 29] and >12 mg/dl in approximately 60% of patients 1 year post-transplant [29]. There are several prospective studies looking at the changes in Lp(a) after transplantation.…”

Section: Discussionsupporting

confidence: 92%

“…The same result was not found in all studies [32, 33]. Brown et al [29] found in a cross-sectional study that patients treated with CSA had higher levels when compared to individuals treated with azathioprine and prednisolone (median –32 vs. 18.3 mg/dl). HDL was also higher in the group not taking CSA (1.41 ± 0.4 vs. 1.24 ± 0.39 mmol).…”

Section: Discussionmentioning

confidence: 59%

“…Lp(a) levels decrease after renal transplantation [20, 27] but remain higher than normal [30] and are higher in recipients with proteinuria [26, 31]. Cyclosporin A (CSA) was shown to increase LDL [20] and lower HDL [29]. Patients on CSA in some studies have lower levels of Lp(a) at 1 year when compared to baseline when compared to patients on prednisolone alone [20].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of Renal Replacement Therapy on Plasma Lipoprotein(a) Levels

Rosas¹,

Joffe

Wolfe

et al. 2007

Am J Nephrol

View full text Add to dashboard Cite

Patients with end-stage renal disease (ESRD) have significantly higher levels of lipoprotein(a) [Lp(a)] when compared to control populations. Elevated levels of Lp(a) may play a role in the high incidence of cardiovascular disease in ESRD. We conducted a prospective study to test the hypothesis that plasma levels of Lp(a) decline rapidly after renal transplantation proportional to the improvement in renal function, but are not affected by hemodialysis. All adults that initiated hemodialysis or received a renal transplant from our institution during a 10-month period were invited to participate in the study. Lp(a) levels were obtained immediately prior to the initiation of renal replacement therapy. In transplant recipients, repeat Lp(a) measures were done at 3 days, 5 days, 1 week, 2 weeks, 3 weeks and 4 weeks post-transplant. In hemodialysis patients, repeat Lp(a) measures were done after 3 months. We used a mixed effects model to analyze the effect of time, race and creatinine on Lp(a) after transplant. Lp(a) levels decreased rapidly after renal transplantation. Mean Lp(a) levels at 2 weeks were 35.3% lower than prior to transplantation. Each reduction of 50% in creatinine was associated with a 10.6% reduction in Lp(a) (p < 0.001). In contrast, there was no significant change in Lp(a) after initiation of hemodialysis. The rapid decrease of Lp(a) levels after renal transplantation provides support for a metabolic role of the kidney in Lp(a) catabolism and suggests that the increase in Lp(a) seen in chronic kidney disease is due to loss of functioning renal tissue.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of Renal Replacement Therapy on Plasma Lipoprotein(a) Levels

Rosas¹,

Joffe

Wolfe

et al. 2007

Am J Nephrol

View full text Add to dashboard Cite

show abstract

“…The increased cardiovascular risk profile as a result of cyclosporine is ascribed to both a quantitative increase in LDL particles and an increased oxidizability of the LDL particles (3)(4)(5). Use of cyclosporine is also associated with increased plasma lipoprotein(a) (Lp[a]) (6) and homocysteine levels (7), but these effects are not unequivocal (8). In addition, unfavorable effects on the fibrinolytic system by cyclosporine have been described (9).…”

mentioning

confidence: 99%

Improved Cardiovascular Risk Profile and Renal Function in Renal Transplant Patients after Randomized Conversion from Cyclosporine to Tacrolimus

Artz¹,

Boots²,

Ligtenberg

et al. 2003

Journal of the American Society of Nephrology

107

View full text Add to dashboard Cite

Abstract. Cyclosporine is considered to contribute to the high cardiovascular morbidity and mortality in patients after renal transplantation. Tacrolimus may be more favorable in this respect, but controlled data are scarce. In this prospective randomized study in 124 stable renal transplant patients, the effects of conversion from cyclosporine to tacrolimus on cardiovascular risk factors and renal function were investigated. Follow-up was 6 mo. Statistical analysis was performed by ANOVA for repeated measurements. The serum creatinine level decreased from 137 Ϯ 30 mol/L to 131 Ϯ 29 mol/L (P Ͻ 0.01). Three months after conversion from cyclosporine to tacrolimus, mean BP significantly decreased from 104 Ϯ 13 to 99 Ϯ 12 mmHg (P Ͻ 0.001). Serum LDL cholesterol decreased from 3.48 Ϯ 0.80 to 3.11 Ϯ 0.74 mmol/L (P Ͻ 0.001,) and serum apolipoprotein B decreased from 1018 Ϯ 189 to 935 Ϯ 174 mg/L (P Ͻ 0.001). Serum triglycerides decreased from 2.11 Ϯ 1.12 to 1.72 Ϯ 0.94 mmol/L (P Ͻ 0.001). In addition, both rate and extent of LDL oxidation were reduced. The fibrinogen level decreased from 3638 Ϯ 857 to 3417 Ϯ 751 mg/L (P Ͻ 0.05). Plasma homocysteine concentration did not change. Three months after conversion, plasma fasting glucose level temporarily increased from 5.4 Ϯ 1.3 mmol/L to 5.8 Ϯ 1.9 mmol/L (P Ͻ 0.05). Conversion to tacrolimus resulted in a significant reduction of the Framingham risk score. In conclusion, conversion from cyclosporine to tacrolimus in stable renal transplant patients has a beneficial effect on renal function, BP, serum concentration and atherogenic properties of serum lipids, and fibrinogen.During the past two decades, cyclosporine has proved to be a valuable immunosuppressive drug that has contributed to a significant reduction in the incidence of acute rejection after renal transplantation. However, cyclosporine also increases cardiovascular risk profiles (1). Ultimately, up to 63% of renal transplant patients die of cardiovascular disease (2). The increased cardiovascular risk profile as a result of cyclosporine is ascribed to both a quantitative increase in LDL particles and an increased oxidizability of the LDL particles (3-5). Use of cyclosporine is also associated with increased plasma lipoprotein(a) (Lp[a]) (6) and homocysteine levels (7), but these effects are not unequivocal (8). In addition, unfavorable effects on the fibrinolytic system by cyclosporine have been described (9). Apart from these disadvantageous effects of cyclosporine on several metabolic cardiovascular risk factors, cyclosporine leads to an elevation of BP (4). These side effects not only contribute to the high cardiovascular morbidity in renal transplant patients but also may lead to an accelerated loss of graft function (10 -12).Tacrolimus is like cyclosporine, a calcineurin inhibitor, with even more potent immunosuppressive properties. The use of tacrolimus after renal transplantation is associated with a less unfavorable effect on BP and serum lipid levels, but evidence from controlled studies is scarce (4,13). L...

show abstract

“…31 Patients treated with cyclosporine have higher Lp(a) and HDL levels than those treated with azathioprine and prednisolone. 32 Tacrolimus and cyclosporine can cause similar effects on Lp(a). 31 In the present study, changes in all these parameters were comparable between the tacrolimus and cyclosporine groups, and there was no correlation between the percent change of serum creatinine with Lp(a) and homocysteine in transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Kahvecioğlu

Güllülü²,

Dirican³

2014

Exp Clin Transplant

View full text Add to dashboard Cite

Objectives: Cardiovascular disease is a common cause of morbidity and mortality in patients with chronic kidney failure, before and after a kidney transplant. Oxidation of lipoproteins that contain apolipoprotein B may contribute to the initiation of atherosclerosis. Paraoxonase may prevent cardiovascular disease. We compared the effects of different calcineurin inhibitors on risk factors for cardiovascular disease in kidney transplant recipients. Materials and Methods: In 16 kidney transplant recipients, treatment included tacrolimus in 8 patients and cyclosporine in 8 patients. Hemoglobin, glucose, renal function, lipid parameters, high-sensitivity C-reactive protein, homocysteine, malondialdehyde, paraoxonase activity, and arylesterase activity were measured before transplant and at 1, 6, and 12 months after the transplant. Results: The levels of homocysteine and malondialdehyde did not change significantly in patients who received either tacrolimus or cyclosporine. The high-sensitivity C-reactive protein was decreased (tacrolimus group, 1 mo) and increased (cyclosporine group, 6 and 12 mo) after the kidney transplant. Paraoxonase activity was increased (tacrolimus group, 1 mo). Arylesterase activity was increased (tacrolimus group, 1, 6, and 12 mo; cyclosporine group, 1 and 6 mo). The percentage of change in arylesterase activity was higher at 12 months in the tacrolimus than in the cyclosporine group. Conclusions: Tacrolimus may be more effective than cyclosporine in improving risk factors for cardiovascular disease after kidney transplant.

show abstract

Influence of Immunosuppressive Therapy on Lipoprotein(a) and Other Lipoproteins following Renal Transplantation

Cited by 44 publications

References 13 publications

Effects of Renal Replacement Therapy on Plasma Lipoprotein(a) Levels

Effects of Renal Replacement Therapy on Plasma Lipoprotein(a) Levels

Improved Cardiovascular Risk Profile and Renal Function in Renal Transplant Patients after Randomized Conversion from Cyclosporine to Tacrolimus

Untitled

Contact Info

Product

Resources

About