Are lipid-dependent indicators of cardiovascular risk affected by renal transplantation?

Hyperlipoproteinemia has been reported to frequently occur in kidney transp lanted patients, thus possibly explaining, at least in part, the increased incidence of cardiovascular disease in this population. To evaluate the imp act of renal transplantation (Tx), and related Immunosuppressive therapy, o n plasma lipoprotein and Lp(a) profile, we selected a cohort of kidney tran splanted patients (36 M/14 F; age 33.8 +/- 12.0 yr, range 13-62) lacking si gnificant causes of hyperlipidemia. All patients received a triple immunosu ppressive regimen and showed a stable renal function after Tx (plasma creat inine: 1.36 +/- 0.35 mg/dL). One year after Tx. we found a significant incr ease of total cholesterol (TC), LDL, HDL, ApoB and ApoA-I (p < 0.005), whil e plasma triglyceride levels remained unmodified. Lp(a) plasma levels after Tx were within the normal range and displayed a significant inverse relati onship with apo(a) size. Noteworthy, LDL/HDL ratio and ApoB/ApoA-I ratio in kidney transplanted patients were almost superimposable with those of norm al controls. Specifically, LDL/HDL ratio significantly decreased in 64% of patients after Tx, due to a prevalent increase of HDL, and was associated w ith a moderate amelioration of plasma TG. In a multiple linear regression m odel, post-Tx HDL level was significantly related to recipient's age, gende r, BMI and cyclosporine (CyA) trough levels (Adj-R2 = 0.35, p = 0.0002), wi th gender and CyA trough levels being the better predictors of HDL. In conc lusion, immunosuppressive regimens, in themselves, do not appear to signifi cantly increase the atherogenic risk related to lipoproteins. Rather, other factors can affect the lipoprotein profile and its vascular effects in ren al transplant recipients.