Hyperlipoproteinemia is frequently observed in patients after
renal transplantation and contributes to cardiovascular morbidity and mortality. In addition, it was recently shown that
hypercholesterolemia accelerates the progression of renal disease. In a renal transplant recipient (RTR) with severe
coronary heart disease,
familial hypercholesterolemia and decreased renal function, immunospecific
LDL-
apheresis was instituted since
dietary restrictions failed to sufficiently improve
hyperlipoproteinemia and medication had to be avoided due to drug interactions. Over a period of 36 months 145
LDL-
apheresis treatments were performed at weekly intervals. The desorption of 5600 ml plasma volume allowed a mean reduction of total
cholesterol by 56.6% (from 256 mg/dl to 110 mg/dl), of
LDL-cholesterol by 63.0% (from 163 mg/dl to 58 mg/dl), of Lp(a) by 68.3% (from 34 mg/dl to 11 mg/dl) and of
triglycerides by 49.6% (from 332 mg/dl to 163 mg/dl). Although temporarily decreasing during each
apheresis session by 9.0%,
HDL-cholesterol values increased during the first 9 months of treatment and remained within the normal range (> 45 mg/dl) thereafter.
Cyclosporine A blood trough values were decreased by 32% during
LDL-
apheresis. Symptoms of
angina pectoris rapidly improved and disappeared after 8 months of
apheresis treatment. Initial coronary angiography exhibited serious three-vessel-disease, without the possibility of bypass grafting. Coronary angiography repeated after two years of
therapy showed a regression of the disease. Serum
creatinine levels declined during treatment (from 2.7 mg/dl to 1.8 mg/dl) and
proteinuria did not increase further. This is the first report to show that long-term
LDL-immunoadsorption is a safe and highly effective treatment of severe
hyperlipidemia and
coronary heart disease in a RTR, resulting in regression of vascular pathology. Moreover, amelioration of
hyperlipidemia may have improved transplant function. Multicenter studies are necessary to confirm our results.