[Age and changes in dietary habits affect hyperlipoproteinemia after kidney transplantation]

Atherosclerosis of the blood vessels is the most frequent cause of morbidity and mortality of patients after transplantation of the kidneys with a long-term function of the graft. It is assumed that the most significant risk factor for its development is secondary hyperlipoproteinaemia (HLP). In the development of HLP a number of factors may participate (chronic renal insufficiency, proteinuria, immunosuppressive treatment, diet, increment of body weight, age, genetic factors). The objective of the investigation was to follow changes of the lipid spectrum after renal transplantation and evaluate the impact of different factors which participate in these changes.

The authors investigated in a retrospective metabolic study for a period of 18 months a total of 348 patients after the first cadaverous kidney transplantation. They compared the findings in 34 patients (group I) who had throughout the investigation period a total cholesterol of < or = 5.2 and triacylglycerols < or = 2.3 and group II (314 patients) who had elevated values of these factors. The mean values of different parameters differed highly significantly (group I vs. group II): cholesterol 4.6 +/- 0.4 vs 6.8 +/- 1.5 (p < 0.001), triacylglycerols 1.8 +/- 0.8 vs 3.6 +/- 1.6 (p < 0.001), LDL-cholesterol 2.6 +/- 0.6 vs 4.0 +/- 1.1 (p < 0.001), (all in mmol/l) and HDL/total cholesterol 0.28 +/- 0.07 vs 0.20 +/- 0.09 (p < 0.01). The authors did not detect a difference in the incidence of isoforms of apo E. There were no differences in the mean cyclosporin A levels: 394 +/- 114 vs. 489 +/- 202 (ng/ml) and renal function CCr 1.0 +/- 0.6 vs 0.9 +/- 0.3 (ml/s). In group I there was a significantly higher intake of energy 150 +/- 20 vs. 125 +/- 25 (kJ), of fat 1.6 +/- 0.3 vs. 1.0 +/- 0.2 (g/kg) and disaccharides (by 50%). With this corresponded also a significantly higher increment of BMI 27.4 +/- 4.6 vs. 23.8 +/- 3.3 (p < 0.01). Patients in group II were also significantly older (44.5 +/- 14.1 vs 49.4 +/- 12.5, p < 0.01).

It is assumed that one of the main causes of the development of HLP after transplantation are poor dietary habits of the patients associated with an excessive intake of energy, fats and disaccharides and an increase of body weight. The patient's age is significantly higher. Standard lower doses of immunosuppressive drugs have obviously only a supportive effect.