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Sequential analysis of the lipid profile of children post-renal transplantation
A Singh1, C Tejani, M Benfield
1State University of New York, Health Science Center at Brooklyn, USA.
Insights
Post-transplant lipid abnormalities persist in children, with elevated cholesterol and triglycerides even after one year. Monitoring lipid profiles at one year and considering intervention for high LDL cholesterol is recommended.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Clinical Chemistry
Background:
- Persistent hyperlipidemia and hypercholesterolemia are significant risk factors for accelerated atherosclerosis following organ transplantation.
- Understanding the natural history of lipid abnormalities in pediatric transplant recipients is crucial for long-term outcomes.
Purpose of the Study:
- To evaluate the natural history of lipid abnormalities in children post-transplantation.
- To assess lipid profiles in pediatric transplant patients on a standardized immunosuppression regimen.
Main Methods:
- A cohort of 29 pediatric transplant patients on triple immunosuppression (cyclosporine, azathioprine, prednisone) was studied.
- Monthly fasting blood samples were analyzed for lipid profiles (CHOL, TG, HDL, VLDL, LP(a)).
- Lipid levels were compared to 21 non-immunosuppressed pediatric controls.
Main Results:
- Significant reductions in lipid parameters were observed only after the first year post-transplantation.
- Reductions in HDL and TG levels were noted between 12-15 months.
- CHOL, TG, LDL, and VLDL levels remained significantly elevated compared to controls throughout the study period.
Conclusions:
- Lipid profiles in pediatric transplant patients remain significantly elevated one year post-transplant.
- Measurement of lipid profiles at one year is recommended for all transplant patients.
- Interventional therapy should be considered for persistently elevated CHOL and LDL levels.
Abstract:
Persistent hyperlipidemia and hypercholesterolemia post-transplantation are risk factors for accelerated atherosclerosis. To evaluate the natural history of lipid abnormalities in children post-transplantation, this study utilized a cohort of 29 patients who were all treated with the same three- drug maintenance immunosuppression (cyclosporine, azathioprine, and prednisone) and whose dosing regimen was rigidly controlled. Fasting blood samples were taken monthly to determine lipid profiles measuring total cholesterol (CHOL), triglycerides (TG), high-density lipoprotein cholesterol (HDL), very low density lipoprotein cholesterol (VLDL), and levels of lipoprotein (a) (LP(a)). A mean value was determined for each of five time periods: 0-3 months, 3-6 months, 6-9 months, 9-12 months and 12-15 months post-transplant. A single specimen of fasting lipid profile was drawn from 21 non-immunosuppressed children attending an ambulatory pediatric clinic and used as control. Despite significant reductions in the cyclosporine and prednisone doses post-transplantation, significant reduction in any of the lipid parameters was only noted after the first year. Reductions in the HDL fraction and in the TG level were noted during the 12-15 month period, however the values obtained in the patient population were significantly elevated for CHOL, TG, LDL and VLDL compared to controls. This study, using a fixed protocol, suggests that the lipid profile should be measured at one year post-transplant in all transplant patients, and if subsequent follow-up continues to exhibit abnormally elevated levels of CHOL and LDL, interventional therapy should be considered.