scholarly journals Hyperlipidemia and transplantation: etiologic factors and therapy.

1992 ◽  
Vol 2 (12) ◽  
pp. S238
Author(s):  
J D Pirsch ◽  
A M D'Alessandro ◽  
H W Sollinger ◽  
S J Knechtle ◽  
A Reed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Renal Transplantation ◽  
Total Cholesterol ◽  
Significant Risk ◽  
High Risk Population ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Corticosteroid Withdrawal

Hyperlipidemia is a well-recognized complication of renal transplantation. In long-term survivors of renal transplantation, cardiovascular disease accounts for the majority of patient deaths. In the cyclosporine era, cardiovascular disease has surpassed infection as the number one cause of death. Risk factors in the transplant population for hyperlipidemia include age, male sex, diabetes, prednisone dose, graft impairment, obesity, and antihypertensive therapy. Recently, cyclosporine has been implicated as an aggravating factor in the development of hyperlipidemia after transplantation, although its role has been controversial. Because renal transplant recipients have other significant risk factors for the development of coronary artery disease, the amelioration of hyperlipidemia may improve long-term patient survival. Because most late deaths occur in patients with a functioning graft, long-term graft survival could also be improved. The role of corticosteroids in the development of hyperlipidemia is well established. Recent studies employing corticosteroid withdrawal after transplantation have shown a marked reduction in cholesterol despite the use of cyclosporine. Data on corticosteroid withdrawal in living related transplants at our center show a significant reduction in total cholesterol after steroid withdrawal. Data from heart transplant recipients under corticosteroid-free protocols show a similar reduction in total cholesterol. Other treatments for hyperlipidemia include diet and cholesterol-lowering agents, such as Mevacor (lovastatin; Merck Sharp & Dohme, West Point, PA). The efficacy of lowering cholesterol in this high-risk population is unknown.

scholarly journals Explained and Unexplained Ischemic Heart Disease Risk after Renal Transplantation

2000 ◽  
Vol 11 (9) ◽  
pp. 1735-1743 ◽  
Author(s):  
BERTRAM L. KASISKE ◽  
HARINI A. CHAKKERA ◽  
JOSEPH ROEL
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Renal Transplantation ◽  
Relative Risk ◽  
Renal Transplant ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Calcium Channel Antagonists ◽  
Relative Risks ◽  
Cholesterol Levels

Abstract. Whether the high incidence of ischemic heart disease (IHD) among renal transplant patients can be attributed to the same risk factors that have been identified in the general population is unclear. The risk for major IHD events occurring >1 yr after transplantation among 1124 transplant recipients was estimated by using the risk calculated from the Framingham Heart Study (FHS). The FHS risk predicted IHD (relative risk, 1.28; 95% confidence interval, 1.20 to 1.40; P < 0.001); however, the FHS risk tended to underestimate the risk of IHD for renal transplant recipients. This was largely attributable to increased risks associated with diabetes mellitus and, to a lesser extent, age and cigarette smoking for renal transplant recipients. For men, the relative risks for diabetes mellitus were 2.78 (1.73 to 4.49) and 1.53 for the transplant recipient and FHS populations, respectively; the relative risks for age (in years) were 1.06 (1.04 to 1.08) and 1.05, respectively, and those for smoking were 1.95 (1.20 to 3.19) and 1.69, respectively. For women, the relative risks for diabetes mellitus were 5.40 (2.73 to 10.66) and 1.82, respectively. There was a tendency for the risk associated with cholesterol levels to be higher for transplant recipients, compared with the FHS population, but the risks associated with high-density lipoprotein cholesterol levels and BP appeared to be comparable. Independent of these and other risk factors, the adjusted risk of IHD for the transplant recipient population has decreased. Compared with the era before 1986, transplantation between 1986 and 1992 was associated with a lower relative risk of 0.60 (0.39 to 0.92); transplantation after 1992 was associated with an even lower relative risk of 0.27 (0.11 to 0.63) for IHD. Of concern was the fact that dihydropyridine calcium channel antagonists were associated with an increased risk for IHD (relative risk, 2.26; 95% confidence interval, 1.24 to 4.12; P = 0.008), and this association was independent of other antihypertensive agents and risk factors. Therefore, although the FHS risk predicts IHD after renal transplantation, it tends to underestimate the risks, especially the risk associated with diabetes mellitus. The unexpected finding that dihydropyridine calcium channel antagonists were associated with an increased IHD risk merits further evaluation.

Hyperhomocysteinaemia: a significant risk factor for cardiovascular disease in renal transplant recipients

1994 ◽  
Vol 9 (8) ◽  
pp. 1103-1108 ◽  
Author(s):  
Z. A. Massy ◽  
B. Chadefaux-Vekemans ◽  
A. Chevalier ◽  
C. A. Bade ◽  
T. B. Drüeke ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Renal Transplant ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Renal Transplant Recipients ◽  
Transplant Recipients

scholarly journals Efficacy and Safety of Sitagliptin for the Treatment of New-Onset Diabetes after Renal Transplantation

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Brian P. Boerner ◽  
Clifford D. Miles ◽  
Vijay Shivaswamy
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Kidney Transplant ◽  
Hemoglobin A1c ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
First Line ◽  
New Onset

New-onset diabetes after transplantation (NODAT) is a common comorbidity after renal transplantation. Though metformin is the first-line agent for the treatment of type 2 diabetes, in renal transplant recipients, metformin is frequently avoided due to concerns about renal dysfunction and risk for lactic acidosis. Therefore, alternative first-line agents for the treatment of NODAT in renal transplant recipients are needed. Sitagliptin, a dipeptidyl-peptidase-4 (DPP-4) inhibitor, has a low incidence of hypoglycemia, is weight neutral, and, in a small study, did not affect immunosuppressant levels. However, long-term sitagliptin use for the treatment of NODAT in kidney transplant recipients has not been studied. We retrospectively analyzed renal transplant recipients diagnosed with NODAT and treated with sitagliptin to assess safety and efficacy. Twenty-two patients were started on sitagliptin alone. After 12 months of followup, 19/22 patients remained on sitagliptin alone with a significant improvement in hemoglobin A1c. Renal function and immunosuppressant levels remained stable. Analysis of long-term followup (32.5±17.8 months) revealed that 17/22 patients remained on sitagliptin (mean hemoglobin A1c < 7%) with 9/17 patients remaining on sitagliptin alone. Transplant-specific adverse events were rare. Sitagliptin appears safe and efficacious for the treatment of NODAT in kidney transplant recipients.

scholarly journals Prospective characteristic of cardiovascular risk factors in renal transplant recipients

2020 ◽  
Vol 17 (2) ◽  
pp. 237-247
Author(s):  
M. V. Smaliakova ◽  
N. P. Mitkovskaya ◽  
A. V. Kalachik ◽  
E. A. Grigorenko
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Renal Transplantation ◽  
Cardiovascular Risk Factors ◽  
Postoperative Period ◽  
Complete Blood Count ◽  
Renal Transplant Recipients ◽  
Preoperative Period ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

The aim of the study is assess the dynamics of laboratory and instrumental parameters (these are cardiovascular risk factors) in patients with chronic kidney disease in the preoperative period and after renal transplantation.A single-center prospective cohort study included 43 kidney transplant recipients. Clinical examination, laboratory and instrumental studies were carried out in the preoperative period, in six months and in five years after transplantation. Laboratory tests included a complete blood count, coagulation, biochemical blood test and enzyme-linked immunosorbent assays. The dynamics of structural and functional heart parameters was studied by echocardiography in the preoperative period and in five years.It was found that the blood pressure, pulse rate, and hypotension episodes decreased after renal transplantation. Hyperaldosterone in the preoperative period was more common than after transplantation. It was observed that the blood level of total cholesterol, triglycerides, interleukin-6, tumor necrosis factor-α, and C-reactive protein decreased in the postoperative period. The hyperglycemia incidence significantly decreased by the end of the observation period. It was detected that the NT-proBNP level increased in all recipients in the preoperative period and decreased to normal values in 37.2 % (n = 16) recipients in the postoperative period. The number of red blood cells and the hemoglobin concentration increased and the hyperethropoietinemia incidence decreased in the postoperative period. The glomerular filtration rate was lower in six months after transplantation than in five years.

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