Serum cholesterol changes in long-term survivors of liver transplantation:A comparison between cyclosporine and tacrolimus therapy

The aim of this study was to compare the longterm effect of tacrolimus and cyclosporine therapies on serum cholesterol levels in liver transplant reci pients. We retrospectively studied 127 consecutive adult liver transplant r ecipients who survived for at least 1 year after transplantation. Basal imm unosuppression consisted of cyclosporine plus prednisone in 100 patients an d tacrolimus plus prednisone in 27 patients. Hypercholesterolemia was defin ed as a fasting serum cholesterol level greater than 220 mg/dL. Mean follow -up was 39 months. No statistical significance was found between cyclospori ne- and tacrolimus-treated patients regarding age, sex, diagnosis, and prev ious cholesterol levels; both groups were similar. Significantly more tacro limus-treated patients were steroid free in the first and second year of fo llow-up (tacrolimus, 37% and 63%; cyclosporine, 13% and 32%, respectively; P < .01). In the third year of follow-up, this difference was not significa nt (77% v 56%). The overall incidence of hypercholesterolemia was 34.6% (44 patients). At the end of the study, hypercholesterolemia was found in 24 o f 51 and 14 of 70 patients with and without steroids, respectively (P < .00 2). Also, mean cholesterol levels were 224 +/- 70 and 191 +/- 48 mg/dL befo re and after steroid withdrawal, respectively, P < .001. Hypercholesterolem ia was found in 43.7% of the patients during cyclosporine plus prednisone t herapy compared with 46.1% of the patients during tacrolimus plus prednison e therapy (P < .9). Greater mean cholesterol levels were found in the cyclo sporine group, particularly in the second and third years of follow-up (P < .01). Hypercholesterolemia was found in 22% of the patients during cyclosp orine monotherapy compared with 15% during tacrolimus monotherapy (P < .5). No differences were found in mean cholesterol levels during follow-up when both monotherapy groups were compared. In conclusion, a lower incidence of hypercholesterolemia was achieved in tacrolimus-treated patients, mainly w hen steroids were still part of the immunosuppressive treatment. Copyright (C) 1999 by the American Association for the Study of Liver Diseases.