Combined treatment with low-dose pravastatin and fish oil in post-renal transplantation dislipidemia

Background. The most common cause of post-transplant dyslipidemia is the us e of corticosteroids and cyclosporin-A (CyA). The HMG-CoA reductase inhibit ors have emerged as the agents of first choice in the treatment of post-tra nsplant hyperlipidemia in combination with low fat diet. The objective of t his study was to evaluate the efficacy of combined treatment with low-dose pravastatin and fish oil in post-renal transplantation dislipidemia. Patien ts and Methods: Twenty-four renal transplant patients, 15 men and 9 women a ged from 30 to 60 years with stable renal function were included in this st udy. All patients were transplanted from living related donors and were giv en a stable triple immunosuppressive-therapy, with methylprednisolone, azat hioprine and CyA. All patients were also given a standard diet containing 1 g/kg BW protein, reducing the daily fat to less than 30%, and maintaining at least a 1:1 ratio of saturated to polyunsaturated (or monounsaturated) f ats. A dosage of 20 mg pravastatin (pravachol) and 1 g of fish oil (prolipi d) were added to the diet after dinner, according to our protocol. Blood sa mples were taken after each study period for total cholesterol, LDL-cholest erol, triglycerides, Apo A,, Apo B, Lp(a), creatinine, CPK and fibrinogen d etermination. Results: At the end of the therapeutic protocol with pravasta tin a significant reduction (p < 0.02) of total and LDL-cholesterol was obs erved, but no significant change in triglycerides, HDL, Lp(a), Apo A(1), Ap o B and fibrinogen was shown. At the end of the therapeutic protocol with p ravastatin and fish oil supplement significant changes were seen in TC (p < 0.02), TG (p < 0.03), LDL-C (p < 0.03), Apo A, (p < 0.04) and Apo B (p < 0 .05) concentrations. There were no significant changes in HDL-C and Lp(a) c oncentrations. Renal function and cyclosporine levels were not changed duri ng and after the study. CPK was increased only in one case. Conclusions: It is suggested that if the response to the diet is inadequate, the use of co mbined treatment with low-dose pravastatin and fish oil is a more effective strategy than the pravastatin treatment alone for changing the lipid profi le after renal transplantation. Copyright (C) 2001 S. Karger AG, Basel.