Tacrolimus-based triple-drug immunosuppression minimizes serum lipid elevations in pediatric cardiac transplant recipients

Lipid Profiles in Pediatric Thoracic Transplant Recipients are Determined by Their Immunosuppressive Regimens

“…[5][6][7][8][9]17,18 However, the precise effect of individual or combination of immunosuppressive agents on lipid abnormalities over time remains to be fully elucidated. Within the population of pediatric heart transplant recipients, there are conflicting reports on the degree of hyperlipidemia and precise association with immunosuppressive agents.…”

“…There are data from cross-sectional studies to suggest that the incidence of hyperlipidemia is higher in these children. [5][6][7][8][9] It is also known that allograft vasculopathy (post-transplant coronary artery disease) is the single most important determinant of late graft survival. 10,11 Although the cause of allograft vasculopathy is not clear, and most likely multifactorial, there is mounting evidence in adults to suggest that hyperlipidemia plays a significant role.…”

Adverse Effects of Immunosuppression in Pediatric Solid Organ Transplantation

“…[78] Corticosteroids also contribute to dyslipidemia; this can be synergistic with the effects of ciclosporin and tacrolimus. [77] In one study, the most marked increases in total cholesterol and triglyceride levels were seen in children receiving ciclosporin in combination with prednisone dosages >0.1 mg kg day. [77] Sirolimus has also been associated with an increased incidence of hyperlipidemia following solid organ transplantation, affecting primarily total cholesterol and triglyceride levels.…”

“…As with hypertension, ciclosporin-based regimens are associated with a higher risk of dyslipidemia than tacrolimus-based regimens. [67,76,77] Ciclosporin levels have been shown to correlate with lipid profiles. [78] Corticosteroids also contribute to dyslipidemia; this can be synergistic with the effects of ciclosporin and tacrolimus.…”

Three-Year Observational Follow-up of a Multicenter, Randomized Trial on Tacrolimus-Based Therapy with Withdrawal of Steroids or Mycophenolate Mofetil after Renal Transplant

“…There is now focus on investigating whether it is possible to withdrawal one or more agents to reduce complications of immunosuppression (3)(4)(5)(6) without compromising long-term patient and graft survival. While tacrolimus use is associated with more favorable lipid parameters and less hypertension (7)(8)(9), ciclosporin, sirolimus and especially steroids are known to exacerbate cardiovascular risk factors (10 -12). Early cessation of steroids and steroid-free regimens are interventions to be considered to reduce cardiovascular risk providing that steroid withdrawal or omission does not adversely affect either the incidence of early acute rejection or long-term graft function.…”