EFFECT OF EARLY HYPERLIPIDEMIA ON GRAFT AND PATIENT SURVIVAL IN CYCLOSPORINE-TREATED RENAL-TRANSPLANT PATIENTS

Hyperlipidemia commonly occurs following renal transplantation. As hyperlipidemia has been postulated to contribute to renal dysfunction in animal models, the effect of early hyperlipidemia was studied in a cohort of 43 cyclosporinetreated renal transplant recipients over a 4-year follow-up period. Hypercholesterolemia occurred in 25 patients, with 18 patients remaining normolipidemic during the initial 3 months following transplantation. Prospective follow-up over a 4-year period was available for 16 of the 18 normolipidemic patients and 25 patients who developed hyperlipidemia, as well as 11 other hyperlipidemic patients who were not included in the initial analysis. Graft function was maintained in 11 (69%) of the patients with early normolipidemia and there has been one patient death (7%). Of the hypercholesterolemic group, two patients were lost to follow-up and 23 of the remaining 34 (68%) had persistant graft function. There have been two patient deaths (6%). No deaths from cardiovascular deaths have occurred in either group, all deaths resulting from infection/sepsis. Mean cholesterol values at 4-year follow-up were 202.0 ± 11.2 mg/dL for the patients with early normolipidemia and 282.9 ± 14.3 mg/dL for the patients with early hyperlipidemia (P < 0.00001). The most recent cholesterol value was not associated with pretransplant cholesterol value, creatinine, or cyclosporine dose, but was associated with cholesterol value at 3 months both by regression analysis (P < 0.0001) and by Pearson R (r = 0.71, P < 0.0001). Early posttransplant hypercholesterolemia persisted for the 4-year follow-up period despite decreasing doses of immunosuppression and was independent of renal function, weight gain, and cyclosporine dose, but highly correlated with early posttransplant cholesterol value. The relationship of hypercholesterolemia to prednisone dose was complex and did not follow a simple linear correlation. Early posttransplant hypercholesterolemia was not associated with excess patient or graft loss over the 4-year follow-up period. These data suggest that early hypercholesterolemia is not a major determinant of graft loss, although we cannot exclude a role for hypercholesterolemia in accelerating the rate of declining renal dysfunction in patients with chronic rejection or other renal diseases. © 1993, National Kidney Foundation. All rights reserved. All rights reserved.