Hyperlipidemia in adult, pediatric and diabetic renal transplant recipients
Ibels, L.S.; Alfrey, A.C.; Weil, R.
American Journal of Medicine 64(4): 634-642
1978
ISSN/ISBN: 0002-9343 PMID: 206137 Document Number: 135255
Serum cholesterol and triglyceride concentrations were measured and lipoprotein electrophoreses were performed on serum samples from 175 adult, 19 pediatric and 11 diabetic transplant recipients and from 102 healthy volunteer subjects. Serum lipids were also measured in 14 patients prior to and for 40 wk following transplantation. The mean serum cholesterol and triglyceride concentrations were greater in all 3 groups of transplant recipients than in the healthy volunteer subjects but there were no differences in serum lipids between any 2 of the transplant recipient groups. Sixty-one percent (125) of the patients had hyperlipidemia. Lipoprotein electrophoreses demonstrated that the hyperlipoproteinemia was heterogeneous, 26% (46) of the patients had type IV hyperlipoproteinemia, 23% (39) type 11b and 11% (19) type 11A. Serum lipid concentrations in patients receiving alternate day corticosteroid therapy were not different from those receiving daily corticosteroid therapy. Positive correlations were found between serum triglyceride concentrations and the daily prednisone dosage, relative body weight, serum creatinine and blood glucose concentrations. No correlation was found between prednisone dosage and the latter 3 variables. A positive correlation was found between serum triglycerides and relative body weight in the healthy volunteer subjects, but for any given body weight serum triglycerides were significantly greater in the transplant recipients. Transplant recipients with hypercholesterolemia were receiving a larger prednisone dosage than those with normal serum cholesterol levels. Serum cholesterol and triglyceride levels became abnormal within 8 wk of transplantation and remained abnormal throughout the remaining 32 wk during which these patients were followed. Correlations were found between serum cholesterol and triglyceride levels and the cumulative dose of prednisone during this 40 wk period. Hyperlipidemia is very common in renal transplant recipients, is a mixture of types 11A, 11B and IV hyperlipoproteinemia, is equally prevalent in diabetic, pediatric and adult transplant recipients and is not diminished by the use of alternate-day corticosteroids. Prednisone dosage, obesity and the degree of impairment of graft function appear to be responsible for hypertriglyceridemia; prednisone dosage appears to be responsible for hypercholesterolemia. Serum lipid abnormalities develop within eight weeks of transplantation and can be related to the cumulative dose of prednisone in the early post-transplant period.