Lipid abnormalities in stable liver transplant recipients – effects of cyclosporin, tacrolimus, and steroids

Abstract Dyslipidemia is common after liver transplantation, but the underlying mechanisms are largely unknown. We studied the lipid profile of 27 liver transplant recipients randomized to receive either cyclosporin (CyA, n = 14) or tacrolimus (n = 13) and compared them with 20 healthy, matched controls. Before transplantation, patients presented low total and low-density lipoprotein (LDL) cholesterol (as compared to controls) that increased shortly, i. e., 3 months, after transplantation. Eighteen months post-transplantation, total and LDL cholesterol levels decreased to pretransplant values but tended to remain higher in CyA-treated patients. However, at that time, prednisone treatment was more prevalent among CyA-treated than tacrolimus-treated patients and fully accounted for the difference in cholesterol levels. Indeed, regardless of therapy, patients not receiving prednisone exhibited lower cholesterol levels than prednisone-treated patients and controls. We conclude that prednisone therapy, rather than CyA or tacrolimus immunosuppression, seems to be the major determinant of increased cholesterol levels.

[1]  S. Knechtle,et al.  Effect of steroid withdrawal on hypertension and cholesterol levels in living related recipients. , 1991, Transplantation proceedings.

[2]  H. Bismuth,et al.  Lipid and apolipoprotein changes after orthotopic liver transplantation for end-stage liver diseases. , 1992, Clinica chimica acta; international journal of clinical chemistry.

[3]  R. Busuttil,et al.  Hyperlipidemia after liver transplantation: natural history and treatment with the hydroxy-methylglutaryl-coenzyme A reductase inhibitor pravastatin. , 1996, Transplantation.

[4]  P. Hudgins,et al.  Steroid withdrawal after pediatric liver transplantation. , 1994, Transplantation proceedings.

[5]  C. V. van Buren,et al.  LIPID ABNORMALITIES IN CYCLOSPORINE‐PREDNISONE‐TREATED RENAL TRANSPLANT RECIPIENTS , 1989, Transplantation.

[6]  J. Gornbein,et al.  SERUM LIPID ABNORMALITIES IN PEDIATRIC LIVER TRANSPLANT PATIENTS1 , 1992, Transplantation.

[7]  W. Bechstein,et al.  Cardiovascular risk factors in long-term follow-up after orthotopic liver transplantation. , 1997, Clinical transplantation.

[8]  J. Walls,et al.  Alterations in lipid and carbohydrate metabolism attributable to cyclosporin A in renal transplant recipients. , 1986, British medical journal.

[9]  B. Kasiske,et al.  Persistent Hyperlipidemia in Renal Transplant Patients , 1987, Medicine.

[10]  J. Mann,et al.  Adverse effect of cyclosporin on plasma cholesterol in renal transplant recipients. , 1988, Nephrology, Dialysis and Transplantation.

[11]  D. Hricik,et al.  Steroid withdrawal after renal transplantation. , 1994, Clinical transplantation.

[12]  W. Bechstein,et al.  THE EFFECT OF FK506 VERSUS CYCLOSPORINE ON GLUCOSE AND LIPID METABOLISM—A RANDOMIZED TRIAL , 1994, Transplantation.

[13]  H. Isoniemi,et al.  LONG‐TERM CONSEQUENCES OF DIFFERENT IMMUNOSUPPRESSIVE REGIMENS FOR RENAL ALLOGRAFTS , 1993, Transplantation.

[14]  G. Wilson,et al.  Impact of serum lipids on long-term graft and patient survival after renal transplantation. , 1995, Transplantation.

[15]  K. Rentsch,et al.  Relation of cyclosporine blood levels to adverse effects on lipoproteins. , 1994, Transplantation.

[16]  R. Busuttil,et al.  A randomized prospective trial of steroid withdrawal after liver transplantation. , 1995, Transplantation.

[17]  R. Merion,et al.  Corticosteroid withdrawal after liver transplantation. , 1995, Surgery.

[18]  G. Klintmalm,et al.  Hyperlipidemia after liver transplantation: long-term results of the FK506/cyclosporine A US Multicenter Trial. US Multicenter Study Group. , 1995, Transplantation proceedings.

[19]  F. González-Sastre,et al.  Quick method of determining lipoproteins, including those of intermediate density, in serum. , 1988, Clinical chemistry.

[20]  M. Moritz,et al.  Hyperlipidemia and obesity after orthotopic liver transplantation. , 1991, Transplantation proceedings.

[21]  H. Bismuth,et al.  Prevalence of dyslipidemia in liver transplant recipients. , 1992, Transplantation.

[22]  L. Ibels,et al.  Hyperlipidemia in adult, pediatric and diabetic renal transplant recipients. , 1978, The American journal of medicine.

[23]  G. Blackburn,et al.  Effectiveness of orthotopic liver transplantation on the restoration of cholesterol metabolism in patients with end-stage liver disease. , 1987, Gastroenterology.

[24]  W. Bennett,et al.  Enhancement of FK506 nephrotoxicity by sodium depletion in an experimental rat model. , 1994, Transplantation.

[25]  J. Buckels,et al.  Serum lipids and apolipoproteins in liver transplant recipients: a comparative study of cyclosporin A and FK 506. , 1994, The Journal of laboratory and clinical medicine.

[26]  M. Manns,et al.  Influence of long-term cyclosporine or FK 506 therapy on glucose and lipid metabolism in stable liver graft recipients. , 1995, Transplantation proceedings.

[27]  J. Barkun,et al.  Maintenance immunosuppression using cyclosporine monotherapy in adult orthotopic liver transplant recipients. , 1996, Transplantation proceedings.

[28]  M. Schwartz,et al.  Serum lipid changes in liver transplant recipients in a prospective trial of cyclosporine versus FK506. , 1994, Transplantation.