Lipid Disorders in Renal Transplant Recipients

There is disagreement about the prevalence and character of lipoprotein lipid abnormalities in renal transplant patients. To test the hypothesis that these abnormalities may be related to the coexistence of medical conditions and medications which affect lipoprotein metabolism in these patients, triglyceride (TG), cholesterol (C), high-density lipoprotein (HDL) and HDL-C subfractions were measured in 26 transplanted patients (10 F/16 M), control subjects matched for age, sex, weight and race and uremic patients being treated with hemodialysis. Female transplant recipients had higher TG (181 ± 47 vs. 68 ± 6 mg/dl; p < 0.001), C (242 ± 19 vs. 165 ± 9 mg/dl; p < 0.01), and low-density lipoprotein (LDL)-C (155 ± 15 vs. 93 ± 8 mg/dl; p < 0.01) than controls. Levels of HDL-C were similar, but HDL₂ was significantly lower in the transplanted patients (9 ± 2 vs. 19 ± 2 mg/dl; p < 0.01). Compared to the uremic patients, female transplanted patients had higher C (242 ± 19 vs. 178 ± 22 mg/dl; p < 0.01), LDL-C (155 ± 15 vs. 94 ± 18 mg/dl; p < 0.01), HDL-C (51 ± 5 vs. 32 ± 4 mg/dl; p < 0.001) and HDL₃-C (42 ± 4 vs. 26 ± 2 mg/dl; p < 0.001); however, HDL₂-C levels were not significantly different. Similarly, male transplanted patients had higher TG (166 ± 26 vs. 100 + 12 mg/dl; p < 0.01), C (213 ± 10 vs. 158 ± 3 mg/dl; p < 0.01), LDL-C (126 ± 9 vs. 97 ± 3 mg/dl; p < 0.05) and HDL-C (54 ± 4 vs. 41 ± 3 mg/dl; p < 0.05) than controls and higher HDL (54 ± 4 vs. 36 ± 4 mg/dl; p < 0.05) and HDL₃(47 ± 3 vs. 30 ± 2 mg/dl; p < 0.05) than uremic patients. However, HDL₂-C levels did not differ among the transplanted, control or uremic groups. Thus, both male and female renal transplant recipients who are otherwise healthy have elevated plasma TG, C and LDL-C and normal to high levels of HDL-C; however their HDL₂-C levels are low. These abnormalities may explain why renal transplant recipients have an increased incidence of atherosclerotic vascular disease.

Section: Discussionsupporting

confidence: 91%

“…These abnormalities are similar to what has been reported previously [5][6][7][8][9] and may be associated with an increased risk of atherosclerotic vas cular disease [13].…”

Section: Discussionsupporting

confidence: 90%

Lipoprotein Lipid Abnormalities in Healthy Renal Transplant Recipients: Persistence of Low HDL<sub>2</sub> Cholesterol

Ettinger¹,

Bender²,

Goldberg³

et al. 1987

“…Previous studies have demonstrated an increase in total cholesterol (TC) and HDL-cholesterol (HDL-C), alone or in combination with increases in trigly ceride (TG), LDL-cholesterol (LDL-C), or lipoprotein(a) among Caucasian renal allograft recipients [1][2][3][4][5]. Abnor malities in lipid metabolism after renal transplantation had been attributed to the administration of corticosteroids, cyclosporin A, diuretics, and [1-blockers, as well as allograft dysfunction, proteinuria, high blood glucose, and obesity [6][7][8][9][10][11][12]. The hyperlipidémie effects of the immunosup Accepted : July 14.1993 pressive agents are most pronounced shortly after renal transplantation, when high dosages are being administered.…”

Section: Introductionmentioning

confidence: 99%

Hyperlipidemia after Renal Transplantation: Treatment with Gemfibrozil

Chan

Cheng²,

Tam³

1994

Thirty-eight renal allograft recipients who had persistent hyperlipidemia and stable renal function 27.8 ± 18.2 months after renal transplantation were treated with gemfibrozil. Gemfibrozil therapy resulted in a decrease in the levels of total cholesterol (TC; 297.6 ± 41.0 mg/dl to 249.2 ± 43.7 mg/dl, -16.3%; p < 0.0001), triglyceride (TG; 231.9 ± 116.8 to 125.7 ± 58.4 mg/dl, -45.8%, p < 0.0005), and LDL-cholesterol (LDL-C; 203.8 ± 37.4 to 174.5 ± 42.5 mg/dl, -14.4%; p = 0.001), which were sustained for 29.1 ± 16.0 months. Comparison of sequential lipid profiles between gemfibrozil-treated individuals and untreated hyperlipidemic controls matched for age, sex, time after transplantation, and the degree of hyperlipidemia, showed that gemfibrozil-treated patients had lower levels of TC (239.9 ± 39.5 vs. 272.8 ± 34.1 mg/dl; p < 0.005), TG (125.7 ± 67.3 vs. 167.3 ± 69.0 mg/dl; p < 0.05), and LDL-C (160.2 ± 41.3 vs. 185.3 ± 26.6 mg/dl; p < 0.05) on serial follow-up. No significant side-effect was observed with gemfibrozil therapy. Our data showed that gemfibrozil was a safe and effective drug for the treatment of hyperlipidemia in renal allograft recipients, which could reduce these patients’s long-term cardiovascular risks.

“…Previous studies analys ing factors associated with elevated serum lipid concen trations have reported conflicting results. Corticoste roids [4,5,[8][9][10][11]13,19], ciclosporin [15,17,[20][21][22], diuretics [12], [$-adrenoreceptor blocking drugs [14], declining renal function [8,9,12,16,18], proteinuria [16,18], obesity [6,8,15] and impaired glucose tolerance [8] have all been impli cated. Other investigators, however, have failed to con firm these observations [23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Hyperlipidemia in Stable Renal Transplant Recipients

Divakar¹,

Bailey²,

Frampton³

et al. 1991

Hyperlipidemia is a major risk factor for atherosclerosis and probably contributes to the increased cardiovascular mortality following renal transplantation. We studied the lipid profiles of 62 adults (29 males) with stable renal function (mean plasma creatinine 0.14 mmol/l, SD 0.07), 7 months to 21 years after renal transplantation. Fifteen patients (24%) were above the age- and sex-adjusted 95th percentile for total triglyceride and 10 (16%) for total cholesterol concentrations when compared with a local reference population. The most common lipoprotein abnormalities were type IIa (19%) and type lib (13%). Multiple regression analysis demonstrated that the use of diuretics and angiotensin-converting enzyme inhibitors were significant factors determining plasma triglyceride concentrations. There were significant bivariate associations between plasma triglyceride concentration and duration since transplantation, plasma creatinine concentration and the use of ciclosporin and diuretics. Duration since transplantation and ciclosporin use were significant factors determining lower plasma cholesterol concentrations. The use of ciclosporin and diuretics was associated with a significantly higher apolipoprotein (apo) B concentration. The cholesterol/HDL cholesterol risk ratio correlated poorly with the apo B/apo A-1 ratio. The value of these ratios as predictors of coronary artery disease need to be established in renal transplant recipients.