Tacrolimus conversion improves hyperlipidemic states in stable liver transplant recipients

With improvements in surgical technique and the advent of new and more effe ctive immunosuppressive agents, survival rates in liver transplant recipien ts have dramatically improved. However, hyperlipidemia frequently develops in patients administered cyclosporine-based immunosuppression long-term, al though it appears to occur less often with newer, tacrolimus-based regimens . We sought to determine whether an isolated change in the baseline immunos uppressive regimen (cyclosporine to tacrolimus) would improve hyperlipidemi c states in these patients. Twenty-one long-term stable liver transplant re cipients with hyperlipidemia, manifested by elevated cholesterol and/or tri glyceride levels, were offered conversion to tacrolimus from cyclosporine A therapy. Lipid profiles were monitored at baseline (while on cyclosporine therapy) and at 1 and 3 months after conversion to tacrolimus therapy. Ther e were no other medication manipulations. After conversion to tacrolimus th erapy, mean cholesterol levels decreased from 251 to 202 mg/dL at 1 month ( P < .001) and 194 mg/dL at 3 months (P < .001). Similarly, triglyceride lev els decreased from 300 to 207 mg/dL by 1 month (P = .011) and 203 mg/dL by 3 months (P < .001). There was also a statistically significant decrease fo r very low-density lipoprotein levels at 3 months (P = .005) and low-densit y lipoprotein levels at 1 and 3 months (P = .013 and P = .014, respectively ). High-density lipoprotein levels did not significantly change after conve rsion to tacrolimus therapy. Conversion was not accompanied by adverse side effects, and patients tolerated the change well. In conclusion, simple con version from cyclo-sporine to tacrolimus-based immunosuppression therapy is safe and improves posttransplantation hyperlipidemia in a subgroup of live r transplant recipients.