IMPACT OF TIME-INTERVAL AFTER TRANSPLANTATION AND THERAPY WITH FIBRATES ON SERUM-CHOLESTEROL LEVELS IN RENAL-TRANSPLANT PATIENTS

It is unclear to what extent different immunosuppressive regimens cont ribute to increased serum cholesterol levels observed in renal transpl ant patients after prolonged periods of immunsuppression (i. e. 3 and 5 years following kidney grafting). Therefore 2 groups of renal transp lant patients were evaluated with respect to serum cholesterol 3 years (n = 103) and 5 years (n = 66) after transplantation: Group 1: predni sone (Pred)/azathioprine (Aza) [3 years (y): n = 52; 5 y: n = 49; mean prednisone dose 12 +/- 1 mg/day]; group 2: cyclosporine A (CsA) alone or in combination with Pred (3 y: n = 51; 5 y: n = 17; prednisone dos e 4 +/- 2 mg/day, p <0.001 vs group 1). The groups were similar with r espect to age, sex, body mass index, time interval after transplantati on, underlying kidney diseases and concomitant drug therapy. Serum cho lesterol levels were persistently higher in patients of group 2 when c ompared to group 1 (3 years: 7.3 +/- 0.2 vs 6.7 +/- 0.2 mmol/l, p <0.0 1; 5 years: 7.5 +/- 0.1 vs 6.6 +/- 0.3 mmol/l, p <0.01) despite 75% lo wer daily doses of Pred (p <0.001) in CsA treated patients (group 2). Before transplantation, patients exhibited a similar distribution of s erum cholesterol levels when compared to age, sex and body mass index matched healthy subjects. In contrast 3 and 5 years following transpla ntation 72% of the patients had serum cholesterol levels above 6.5 mmo l/l, whereas in normal subjects, 60% had serum cholesterol levels belo w 6.5 mmol/l. Therapy with diet and fibrates (n = 33) decreased serum cholesterol in patients of group 1 (n = 15; therapy for 66 +/- 7 month s) and group 2 (n = 18; therapy for 33 +/- 4 months) from 8.1 +/- 0.4 mmol/l to 7.0 +/- 0.3 (p = 0.02) and from 9.6 +/- 0.4 mmol/l to 7.0 +/ - 0.3 (p <0.001), respectively, however still being elevated compared to normal controls (p <0.01). In summary: Serum cholesterol is increas ed in kidney transplant patients irrespective of the type of immunosup pressive regimen and remains elevated to the same extent after 3 and 5 years on treatment. Renal transplant patients treated with CsA alone or in combination with Pred have higher serum cholesterol levels than patients on Aza/Pred treatment. Hypercholesterolemia in renal transpla nt patients may effectively and safely be treated with various fibrate s.