Hypercholesterolemia is a common problem among transplant recipients. Despite package-insert warnings about the potential side effects of the use of
statins in patients with chronic
liver disease, they are often prescribed for
liver transplant recipients. Unlike
statins,
ezetimibe acts through inhibition of enterohepatic recirculation of
lipids. We report the effectiveness and safety of
ezetimibe among
liver transplant recipients because this has been evaluated previously only in kidney and heart transplant patients. A consecutive cohort of 25 liver graft recipients with serum
low-density lipoprotein (
LDL) levels > 100 mg/dL (2.5 mmol/L) after a mean (+/-standard deviation) of 55 +/- 21 months following
liver transplantation received
ezetimibe (10 mg orally every day) for at least 6 months. Serum
lipid profiles, liver and renal function tests, and dosages and blood levels of the immunosuppression drugs at baseline, 3 months, and 6 months were prospectively collected. The overall mean age was 58 +/- 12 years, and 56% were males.
Statin therapy and
fibrates were already being used in 32% and 20% of recipients for elevated
LDL and/or
triglycerides, respectively. The immunosuppression regimen included
cyclosporine in 48% of subjects,
tacrolimus in 32%,
sirolimus in 48%, and
mycophenolate mofetil in 44%; only 12% were on oral
prednisone with a maximum daily dose of 5 mg. After
ezetimibe was started, an 18% reduction in
LDL values was observed [at baseline, 147 +/- 35 mg/dL (3.8 +/- 0.9 mmol/L), and at 6 months, 120 +/- 31 mg/dL (3.1 +/- 0.8 mmol/L); P = 0.010]. After 6 months, an additional 32% achieved the target
LDL level of <100 mg/dL. None of the remaining variables, including immunosuppression
drug levels, varied significantly during
ezetimibe therapy. None of the subjects required adjustments in their pharmacological dosages. One discontinued
ezetimibe 3 months later because of cost, 2 subjects had minimal
nausea, 1 subject had myalgias without a rise in
creatine phosphokinase, and 1 subject had a transient elevation (3-5 times) in liver
enzymes from baseline with increases in the total and indirect
bilirubin levels. In conclusion, among
liver transplant recipients,
hypercholesterolemia can be effectively treated with
ezetimibe with few side effects and no interaction with immunosuppressive regimens.