Post liver transplant refractory dyslipidemia

Abstract

A 53-year-old male presented with intractable pruritus and jaundice. He underwent liver transplantation for liver cirrhosis a year prior to the current presentation. Post-transplantation, he developed diabetes mellitus. He experienced an episode of early acute graft rejection, 2 months after transplantation, which was successfully treated. Subsequently, about a year after transplantation, he developed chronic graft rejection. He was treated with everolimus and prednisolone. Incidentally, he was found to have elevated blood cholesterol, triglycerides, and low density lipoprotein (LDL) levels. The lipid levels were significantly higher than those commonly encountered in post-liver transplant patients. Dyslipidemia was treated with maximum dose of high-intensity statin, ezetimibe, and fenofibrate. However, there was not much reduction in lipid levels, indicating resistance to treatment. Subsequently, injection evolocumab 140 mg subcutaneously was added, administered once every 2 weeks. Following that, after only three doses of injection, there was about 65% reduction in the LDL level, which sustained at lower levels with continued treatment using evolocumab. Evolocumab was proven to be highly effective in reducing lipid levels in post-liver transplant patients who are refractory to treatment with conventional lipid-reducing medications.