REGRESSION OF CORONARY ATHEROSCLEROSIS AND AMELIORATION OF RENAL-FUNCTION DURING LDL-IMMUNOADSORPTION THERAPY IN A RENAL-TRANSPLANT RECIPIENT

Hyperlipoproteinemia is frequently observed in patients after renal tr ansplantation and contributes to cardiovascular morbidity and mortalit y. In addition, it was recently shown that hypercholesterolemia accele rates the progression of renal disease. In a renal transplant recipien t (RTR) with severe coronary heart disease, familial hypercholesterole mia and decreased renal function, immunospecific LDL-apheresis was ins tituted since dietary restrictions failed to sufficiently improve hype rlipoproteinemia and medication had to be avoided due to drug interact ions. Over a period of 36 months 145 LDL-apheresis treatments were per formed at weekly intervals. The desorption of 5600 mi plasma volume al lowed a mean reduction of total cholesterol by 56.6% (from 256 mg/dl t o 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 b y 49.6% (from 332 mg/dl to 163 mg/dl). Although temporarily decreasing during each apheresis session by 9.0%, HDL-cholesterol values increas ed during the first 9 months of treatment and remained within the norm al range (>45 mg/dl) thereafter. Cyclosporine A blood trough values we re 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 repe ated after two years of therapy showed a regression of the disease. Se rum 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 re port to show that long-term LDL-immunoadsorption is a safe and highly effective treatment of severe hyperlipidemia and coronary heart diseas e in a RTR, resulting in regression of vascular pathology. Moreover, a melioration of hyperlipidemia may have improved transplant function. M ulticenter studies are necessary to confirm our results.