Lipoprotein profile changes in children after renal transplantation in the modern immunosuppression era

Abstract

There are little data on prevalence of dyslipidemia in pediatric kidney TX recipients in the modern IS era. LP profiles of 38 TX recipients receiving triple IS with MMF, prednisone, and tacrolimus were compared with those of 11 children on HD using mixed model multiple linear regression analysis of repeated measures after adjusting for age, sex, ethnicity, duration of ESRD, and BMI. TC and LDL levels were significantly higher in TX compared with HD, whereas there was no difference in the HDL, VLDL, and TG levels. TC and LDL in TX children had no association with age, sex, ethnicity, and duration of ESRD, stage of chronic kidney disease, DM, BMI percentile, and gain in percentage IBW. Five children treated with atrovastatin had a significant reduction in TC, LDL, VLDL, and TG at 3-6 months post-treatment compared with pretreatment levels, whereas there was no difference in HDL or tacrolimus levels after treatment. No side effects of therapy were observed. Although dyslipidemia remains a significant problem in pediatric renal TX recipients in the modern era, the prevalence may have decreased with use of newer IS drugs.

Dyslipidemia after pediatric renal transplantation—The impact of immunosuppressive regimens

“…Importantly, our data show a strong association of TG, TC, and LDL‐C with immunosuppressive therapy, confirming previous smaller studies in pediatric solid organ transplant recipients . Notably, virtually all patients in the CERTAIN Registry received steroids during the first year post‐transplant that have been shown to contribute significantly to hypercholesterolemia and can even exaggerate the effect of CNIs on lipid metabolism in a synergistic manner.…”

“…In contrast, dyslipidemia, which is also highly prevalent in pediatric patients with CKD as well as in renal transplant recipients, has not gained much attention in pediatric nephrology, although strong evidence from autopsy, vascular, and cohort studies have indicated that pediatric dyslipidemia is associated with an increased risk of atherosclerosis and that atherosclerotic lesions are present decades before manifestation of coronary heart disease …”

“…In large adult renal transplant studies, dyslipidemia is independently associated with cardiovascular events after kidney transplantation as well as with the development of chronic allograft dysfunction . Data on prevalence of dyslipidemia are comparable among adult and pediatric renal transplant recipients and concern about 60% of patients. In adults, dyslipidemia has been shown to be among the most relevant modifiable cardiovascular risk factors for the survival of renal transplant recipients …”

KDOQI Clinical Practice Guideline for Nutrition in Children with CKD: 2008 Update

“…223,500-503 The risk and rates of posttransplantation dyslipidemia may differ based on the type of immunosuppression used, with lower prevalences reported with more recent protocols, including those that are steroid free. [504][505][506] It is estimated that there are 20 cardiovascular events/1,000 patients per year after transplantation. 507 Immunosuppressive agents, especially calcineurin inhibitors, directly contribute to side effects of hypertension, hyperlipidemia, and nephrotoxicity.…”

Dyslipidemia after renal transplantation: A cause for concern?

“…The study by Sgambat et al. (5) in the current issue of Pediatric Transplantation adds valuable information to the existing medical literature on dyslipidemia after renal Tx. The investigators serially analyzed fasting lipoprotein profiles in 38 stable children who were at least six months post‐transplant and were receiving a more contemporary immunosuppressive regimen consisting of lower dose corticosteroids (0.1 mg/kg/day of prednisone), tacrolimus and mycophenolate mofetil (or azathioprine in a few patients).…”