HYPERLIPIDEMIA IN LONG-TERM SURVIVORS OF PEDIATRIC RENAL-TRANSPLANTATION

The prevalence of hyperlipidemia in adolescents and young adults who a re long-term survivors of pediatric renal transplantation with stable graft function has not previously been examined. We studied 33 renal t ransplant recipients aged 5 to 23 years, who were an average of 7.4 ye ars (range 3 to 11 years) post-transplant. We found hypercholesterolem ia in 17 (total cholesterol (TC) > 5.18 mmol / 1). Both low-density li poprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels were increased, such that the mean TC/HDL-C and apolip oprotein B/apolipoprotein Al (Apo B/Apo A1) ratios were below levels a ssociated with increased coronary artery disease risk. Subjects with h ypercholesterolemia did not differ from those with normal cholesterol values in current age or age at transplant, serum creatinine, serum al bumin, serum triglycerides, HDL-C, TC/HDL-C ratio, Apo B / Apo Al rati o, prednisone dose, body mass index, gender, use of thiazides or block ers, or family history of premature atherosclerosis. Coronary risk fac tors appear to cluster in these patients, with hypertension in 53% of those with hypercholesterolemia. Lipid profiles were not different in patients treated with prednisone-azathioprine vs. prednisone-azathiopr ine-cyclosporine A immunosuppression. A significant correlation was fo und between predisone dose (mg/m2) and TC, LDL-C and TC/HDL-C. Accordi ng to National Cholesterol Education Program guidelines, 32% of these long-term survivors of pediatric renal transplantation warrant at leas t dietary intervention and 10% are candidates for treatment with lipid -lowering drugs. This proportion is likely to increase as the safety o f lipid-lowering agents is established in younger children.