PATHOPHYSIOLOGY AND TREATMENT OF LIPID PERTURBATION AFTER CARDIAC TRANSPLANTATION

In this review we examine the complex interactions between lipoprotein metabolism, immunosuppressive drug therapy, and inflammation and the potential benefits of lipid-lowering drug therapy after heart transpla ntation. The newer formulations of cyclosporine, Neoral (Novartis Phar maceuticals; Basle, Switzerland), and other newer agents such as tacro limus may have advantages in regard to lipid metabolism as compared wi th traditional triple-drug immunosuppression. Lipoprotein levels may i nfluence both the toxicity and efficacy of cyclosporine. Dyslipidemia may adversely influence inflammation and rejection in the allograft. T wo recent clinical trials have shown that lipid-lowering therapy with a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor alone or i n combination with low-density lipoprotein apheresis may confer signif icant benefits toward preventing transplant coronary artery disease.