The effects of hyperlipidaemia on graft and patient outcome in renal transplantation

Hyperlipidaemia is a frequent complication after renal transplantation. As to whether total cholesterol (TC) and triglyceride levels are risk factors for cardiovascular disease and graft survival is controversial. The prevalence of hypercholesterolaemia in the transplanted population in Spain has increased over the years, going from 38.8% in 1990 to 48% in 1998. In contrast, the prevalence of hypertriglyceridaemia being similar to20%, has not shown any significant variation. Transplant recipients with high cholesterol were characterized by increased age, lower proportion of males, higher mean body mass index, lower proportion of HCV antibodies, reduced time on dialysis and diabetes. Patients with high cholesterol were more frequently treated with cyclosporine + MMF + prednisone and less frequently treated with tacrolimus + MMF + prednisone. Hypertriglyceridaemia was more frequent in patients treated with cyclosporine + MMF + prednisone, and these patients showed significantly higher creatinine plasma levels at 1 year and were more frequently treated with lipid-lowering agents. Hypertriglyceridaemia at 3 months after transplantation is associated with worse graft survival (RR 1.078; CI 1.07-1.143; P = 0.011) and greater cardiovascular mortality (RR 1.265; CI 1.20-1.428; P = 0.0002), while treatment with statins has a protective effect on the graft survival (RR 0.64; CI 0.512-0.888; P = 0.0051). In conclusion, in the renal transplant population in Spain, hypertriglyceridaemia rather than hypercholesterolaemia, may exert a deleterious effect on graft and patient survival.