CARDIOVASCULAR RISK PROFILE IN KIDNEY-TRANSPLANT RECIPIENTS WITH WELL-CONTROLLED HYPERTENSION

Background and Aim: To study the alterations of carbohydrate and lipid metabolism in a group of renal-transplant recipients. Methods and Res ults: A case-control study was carried out on 44 renal-transplant reci pients with normal kidney function and oral glucose tolerance, and a c ontrol group of 37 healthy subjects. The following variables were stud ied: a) anthropometric and clinical, b) diet, c) composition of the ad ipose tissue fatty acids d) glycemia, insulin, and C peptide at baseli ne and after oral glucose tolerance rest (OGTT), e) cholesterol, trigl ycerides, and Apo B in total plasma and in high density lipoprotein (H DL), very low density lipoprotein (VLDL), intermediate density lipopro tein (IDL), and low density lipoprotein (LDL) separated by ultracentri fugation, Apo A-I, Apo CII, and Apo CIII in plasma. The renal-transpla nt recipients had a greater waist to hip ratio (0.89+/-0.09 vs 0.69+/- 0.07, p=0.0008) compared to controls. Calorie intake was similar but t he transplant recipients had a lower intake of saturated fat per day ( 31.4+/-9.6 vs 37.4+/-10.98 g/day, p=0.05). The composition of fatty ac ids in adipose tissue was the same in cases and controls, except for a greater proportion of lauric acid in the transplant recipients (p=0.0 5). The transplant recipients had significantly higher levels of chole sterol, triglycerides, and Apo B both in plasma and in VLDL, LDL, and IDL. The Apo A-I, Apo CII, and Apo CIII were significantly raised in t he transplant recipients, but the Apo CII/Apo CIII ratio was significa ntly reduced (p=0.005). The HDL levels were similar in the transplant recipients and controls except for the HDL triglycerides, which were s ignificantly higher (p=0.0002). Insulin values in serum were higher in the transplant recipients over the whole glucose curve with statistic ally significant differences at minute 90 of the curve (p=0.05). C pep tide was higher in the transplant recipients at baseline (3.83+/-5.31 ng/ml VS 1.70+/-0.61 ng/ml, p=0.0001) and at minute 180 of the curve ( p=0.03). The C peptide/insulin ratio was also significantly raised at these same times. Transplant recipients with hypertension had higher l evels of blood glucose at minutes 30 (p=0.04) and 90 (p=0.01) of the c urve, as well as a larger area under the glucose curve (p=0.03). They also had significantly higher levels of insulin at minute 90 (p=0.03), total Apo B (p=0.05), Apo B in LDL (p=0.03) and LDL-cholesterol (p=0. 05). Conclusions: The rise in cholesterol and plasma triglycerides, ri te apolipoprotein distribution pattern, the redistribution of the body fat, the changes in carbohydrate and insulin metabolism, are all the expression in renal-transplant recipients of a plurimetabolic syndrome , probably secondary to the simultaneous action of steroids, cyclospor ine and hypotensive agents. (C) 1998, Medikal Press.