Correlation between lipid abnormalities and immunosuppressive therapy in renal transplant recipients with stable renal function.

Abstract

BACKGROUND:

Hyperlipidemia following successful renal transplantation is a frequent and persistent complication. Several immunosuppressive agents including cyclosporine A (CyA), corticosteroids, and tacrolimus appear to have a significant pathogenetic role. The aim of this study is to investigate the differential effects of different immunosuppressive agents on lipids in renal transplant patients.

METHODS:

Two groups of renal transplant recipients, each treated with a different combination of immunosuppressive agents, were studied: Group A (n = 13), cyclosporine A, mycophenolate mofetil (MMF), steroids, and basiliximab; Group B (n = 13), tacrolimus, MMF, steroids, and daclizumab). Plasma lipids [cholesterol (CHOL), low-density lipoprotein (LDL)-CHOL, high-density lipoprotein (HDL)-CHOL, and triglycerides (TG)] were examined before transplantation and 1 and 6 months posttransplantation.

RESULTS:

The patients treated with cyclosporine A-MMF showed a significant increase in mean cholesterol and mean LDL-cholesterol values at the 1-month posttransplantation follow-up compared with pretransplant levels (CHOL: 208.9 +/- 47.4 vs. 268.7 +/- 42.2 mg/dl, P = 0.004; LDL: 118.4 +/- 49.9 vs. 198.7 +/- 40.7 mg/dl, P = 0.002; pretransplant vs. 1 month, respectively). At 6 months, LDL-cholesterol levels were significantly elevated compared with pretransplant levels (LDL: 118.4 +/- 49.9 vs. 148.3 +/- 48.5 mg/dl, P = 0.034), whereas there was no significant change in the cholesterol level during the same period. In cyclosporine A-MMF-treated patients, plasma triglyceride levels were reduced at the 1- and 6-month follow-up (TG: 293.9 +/- 59.2 vs. 182.9 +/- 48.7 mg/dl, P = 0.03; 293.9 +/- 59.2 vs. 178.6 +/- 74.2 mg/dl, +/- = 0.023; pretransplant vs. 1 and 6 months, respectively). Patients receiving combined therapy with tacrolimus-MMF showed no significant changes in LDL-CHOL levels during the trial. Cholesterol levels at 6 months posttransplantation were significantly lower than the pretransplant measurements (CHOL: 182.9 +/- 44.4 vs. 162.3 +/- 37.2 mg/dl, P = 0.024; pretransplant vs. 6 months). A significant reduction in triglyceride level was documented at the 1-month follow-up followed by a subsequent decrease within 6 months (TG: 228.5 +/- 61.6 vs. 147.6 +/- 51.5 mg/dl, P = 0.005; TG: 228.5 +/- 61.6 vs. 130.4 +/- 54.7 mg/dl, P = 0.011; pretransplant vs. 1 and 6 months, respectively).

CONCLUSIONS:

In posttransplant patients with stable renal function cyclosporine therapy is associated with increased cholesterol and LDL-cholesterol levels. Hyperlipidemia is less pronounced in patients given tacrolimus. Tacrolimus appears to an immunosuppressant agent with fewer and less severe adverse effects on lipid metabolism.

• Authors: Despina N Perrea, Konstantinos G Moulakakis, Maria V Poulakou, Ioannis S Vlachos, Nikolaos Nikiteas, Alkiviadis Kostakis
• Journal: International urology and nephrology (Int Urol Nephrol) Vol. 40 Issue 2 Pg. 521-7 ( 2008) ISSN: 0301-1623 [Print] Netherlands
• PMID: 17978855 (Publication Type: Journal Article)

Chemical References

• Cholesterol, LDL
• Immunosuppressive Agents
• Cyclosporine
• Creatinine
• Mycophenolic Acid
• Tacrolimus

Topics

• Adult
• Cholesterol, LDL (blood)
• Creatinine (blood)
• Cyclosporine (adverse effects)
• Female
• Humans
• Hypercholesterolemia (chemically induced, epidemiology)
• Hyperlipidemias (chemically induced)
• Hypertriglyceridemia (epidemiology)
• Immunosuppressive Agents (adverse effects)
• Kidney Failure, Chronic (blood, surgery)
• Kidney Transplantation (adverse effects, immunology, physiology)
• Male
• Middle Aged
• Mycophenolic Acid (adverse effects, analogs & derivatives)
• Tacrolimus (adverse effects)