The influence of pretransplant lipoprotein abnormalities on the early results of renal transplantation

Dimény, Emöke; Tufveson, Gunnar; Lithell, Hans; Larsson, Erik; Siegbahn, Agneta; Fellström, Bengt

doi:10.1111/j.1365-2362.1993.tb00968.x

Cited by 90 publications

(43 citation statements)

References 28 publications

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“…Dimeny et al reported a mean serum cholesterol level of 262 mg/dL and an LDL cholesterol level of 175 mg/dL at 6 months after transplantation in 105 renal transplant recipients (29). Aakhus et al reported a mean total cholesterol level of 279 mg/dL in 403 transplant patients (26).…”

Section: Discussionmentioning

confidence: 99%

Effects of Sirolimus on Lipids in Renal Allograft Recipients: An Analysis Using the Framingham Risk Model

Blum

2002

American Journal of Transplantation

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This report describes the effects of sirolimus on plasma lipids, and uses the Framingham risk model to assess the clinical importance of these effects. Lipid data from two large controlled studies of 1295 renal transplant patients were analyzed retrospectively. Sirolimus 2 mg/day and 5 mg/day were compared with placebo or azathioprine, and administered concomitantly with steroids and cyclosporine over 12 months. Hypercholesterolemia and hypertriglyceridemia occurred in all treatment groups and were maximal at 2-3 months. The sirolimus groups evidenced higher lipid levels than the controls, but the elevations diminished over time. At 1 year, the patients given sirolimus 2 mg/ day had a mean cholesterol level 17 mg/dL greater and a mean triglyceride level 59 mg/dL greater than the controls. Among the patients given sirolimus 5 mg/day, mean cholesterol was 30 mg/dL greater and mean triglycerides were 103 mg/dL greater than the controls. Treatment with statins and fibrates was effective in reducing cholesterol and triglyceride levels, respectively, in the sirolimus-treated patients. The Framingham risk model predicted that the 17 mg/dL elevation in cholesterol would increase the incidence of coronary heart disease (CHD) by 1.5 new cases per 1000 persons per year and CHD death by 0.7 events per 1000 persons per year. Lipid elevations observed in the sirolimus-treated patients were manageable, improved over time, and responded to lipid-lowering therapy. Based on the Framingham risk model, the CHD risks associated with these cholesterol elevations are small compared with the baseline risks of the transplant population.

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Section: Discussionmentioning

confidence: 99%

Effects of Sirolimus on Lipids in Renal Allograft Recipients: An Analysis Using the Framingham Risk Model

Blum

2002

American Journal of Transplantation

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“…In both cross-sectional, retro spective and prospective studies, lipid abnormalities have been reported to be associated with the development of CRAD [4,5,17,18]. As in our case, triglycerides appear to be better predictors than cholesterol for the develop ment of CRAD [ 18], and even a lack of correlation of cho lesterol with the development of CRAD has been de scribed [19], However, more than pointing to a single lip id parameter, our attention should be directed to the glob al lipoprotein profile.…”

Section: Discussionmentioning

confidence: 99%

“…has also been called transplant arteriosclerosis due to the presence of vascular proliferation in small and middle size arteries of the kidney, which resemble early arterio sclerosis lesions [2], In this regard, clinical and experi mental evidence suggests that lipid abnormalities may be involved in the pathogenesis of chronic renal allograft dysfunction (CRAD) [3][4][5].…”

mentioning

confidence: 99%

Increased Lipoproteins and Fibrinogen in Chronic Renal Allograft Dysfunction

Fernández‐Miranda¹,

Morales²,

Porres

et al. 1997

Am J Nephrol

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Chronic rejection – also called chronic renal allograft dysfunction (CRAD) – is the main cause of long-term loss of the transplanted kidney, but its pathogenesis is not well known. The aim of this study was to know if lipoproteins, fibrinogen, plasminogen activator inhibitor-1 (PAI-1) and platelet aggregation show more abnormalities in renal transplant patients with CRAD than in those with stable renal function. Sixty patients with renal allograft have been studied; 20 patients with CRAD and 40 controls matched for age, gender and time after transplantation. In a univariate analysis patients with CRAD had higher total serum triglycerides (214 ± 153 vs. 133 ± 39 mg/dl; p = 0.04) and very-low-density lipoprotein (VLDL) triglycerides (128 ± 116 vs. 59 ± 29 mg/dl; p = 0.04). Apolipoprotein B levels were also increased in patients with CRAD although this difference was only borderline significant (131 ± 58 vs. 98 ± 16 mg/dl; p = 0.05). Similarly, there was a trend toward increased total, VLDL, and low-density lipoprotein (LDL) cholesterol and reduced high-density lipoprotein (HDL) cholesterol in CRAD patients, but these differences did not reach statistical significance. Apolipoprotein A-1 and lipoprotein(a) levels were similar in both groups. Neither platelet aggregation nor PAI-1 levels differed between both groups. In contrast, fibrinogen was increased in patients with CRAD (373 ± 81 vs. 322 ± 62 mg/dl; p = 0.01). In a multivariate analysis triglycerides and fibrinogen were positively correlated to CRAD. These findings add further support to the hypothesis that lipid abnormalities may be involved in the pathophysiology of CRAD. In addition, this is the first report showing that fibrinogen levels are increased in patients with CRAD. Further studies are needed to evaluate a potential role of fibrinogen in the development of CRAD.

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“…Several non-immunological risk factors have been identified to have an impact on the CVR process as well. These factors include ischaemiareperfusion damage, 17,18 hypercholesterolaemia, [19][20][21] hypertension (see below) and obesity. Cytomegalovirus (CMV) infection has been shown in experimental models of CVR 22 and in heart transplantation to influence late development of CVR.…”

Section: Pathogenesis and Risk Factorsmentioning

confidence: 99%

Accelerated atherosclerosis in the transplant recipient: role of hypertension

et al. 1998

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An accelerated atherosclerosis may occur in the native arteries of a transplant recipient as well as in arteries of transplanted kidneys or hearts. The dominating cause of patient mortality are cardiovascular diseases, where ischaemic heart disease is predominant. The accelerated form of arteriosclerosis which takes place in transplanted kidneys and hearts, has a complex pathogenesis, which includes both immunological and non-

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The influence of pretransplant lipoprotein abnormalities on the early results of renal transplantation

Cited by 90 publications

References 28 publications

Effects of Sirolimus on Lipids in Renal Allograft Recipients: An Analysis Using the Framingham Risk Model

Effects of Sirolimus on Lipids in Renal Allograft Recipients: An Analysis Using the Framingham Risk Model

Increased Lipoproteins and Fibrinogen in Chronic Renal Allograft Dysfunction

Accelerated atherosclerosis in the transplant recipient: role of hypertension

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