Renal allograft immunosuppression (original) (raw)

Abstract

Serum lipid and lipoprotein profiles were performed in order to investigate lipid abnormalities 2 years post-transplantation in first cadaveric renal allograft recipients immunosuppressed with cyclosporin (CyA), azathioprine (Aza), and methylprednisolone (MP), or with any combination of two drugs. CyA was used in low doses. Total serum cholesterol, triglyceride, L D L cholesterol, HDL cholesterol, HDL2 cholesterol, HDL3 cholesterol, apolipoprotein A1, and apolipoprotein B were determined in 88 prospectively randomized patients with functioning grafts. When considering only the patients who remained on the original randomized treatment, there were no significant differences between the four groups in any of the measured variables. Mean total cholesterolwas highest in the group receiving Aza and MP (6.8 mmol/1) and lowest in the group receiving triple therapy (5.8 mmol/1; NS). Mean triglyceride level was highest in the group receiving Aza and MP (2.3 mmol/1) versus 1.8-2.2 mmol/1 in the groups receiving triple therapy, Aza + CyA, and CyA + MP. For all patients mean triglyceride level was highest in the group receiving Aza and MP (2.7 mmol/1) and lowest in the group receiving triple therapy (1.7 mmol/1; P<0.05). Mean H D L cholesterol ranged from 1.5 to 1.6 mmol/1 in all groups. Neither CyA concentration nor CyA or MP dose correlated with cholesterol or triglyceride concentration. However, the average MP dose was twice as high in the group receiving Aza and MP as in the other two groups employing steroids. Serum cholesterol and triglyceride concentrations were related to body mass index (r = 0.28, P = 0.045 and r = 0.30, P = 0.029, respectively). Hyperlipidemia was most common in the group receiving Aza and MR The frequency of hypercholesterolemia (serum cholesterol level > 6.5 mmol/1) was 18%, 45%, 60%, and 35% for the patients continuing with the originally randomized treatment in the groups receiving triple therapy, Aza + CyA, Aza + MR and CyA + MP, respectively. In a normal Finnish reference population, 35 % of all males and 31% of all females have a serum cholesterol level above 6.5 mmol/1. Thus, only patients receiving Aza and Offprint requests to: H. Isoniemi MP had a clearly higher frequency of hypercholesterolemia than that found in a normal population. Taken together, this study shows no lipid abnormalities associated with the use of low-dose CyA for 2 years after transplantation. Hyperlipidemia occurring after transplantation is probably multifactorial and more associated with other risk factors than with the immunosuppressive therapy.

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