Related Experiment Videos
Lipoprotein abnormalities are highly prevalent in pediatric heart transplant recipients
C Chin1, D Rosenthal, D Bernstein
1Division of Pediatric Cardiology, Stanford University, California, USA. clifford@leland.stanford.edu
Insights
Pediatric heart transplant recipients frequently have lipid abnormalities, particularly with triglycerides and HDL. Total cholesterol is an unreliable marker for these issues in children post-transplant.
Area of Science:
- Pediatric Cardiology
- Transplant Medicine
- Lipid Metabolism
Background:
- Graft coronary artery disease (GCAD) is a concern post-transplant.
- Hypertriglyceridemia is an independent risk factor for GCAD.
- HMG-CoA inhibitors reduce GCAD in adults, but pediatric data is limited.
Purpose of the Study:
- Characterize lipoprotein profiles in pediatric heart transplant recipients.
- Evaluate total cholesterol (TC) as a marker for lipid abnormalities.
- Compare lipid profiles after switching immunosuppression from cyclosporine A (CsA) to tacrolimus.
Main Methods:
- Analyzed 71 fasting lipoprotein profiles from 28 pediatric heart transplant patients.
- Defined abnormal levels for triglycerides (TG), LDL, and HDL based on age/gender percentiles.
- Compared lipid levels before and after conversion from CsA to tacrolimus.
Main Results:
- 90% of patients exhibited abnormalities in TG or HDL levels.
- LDL levels were generally normal when adjusted for age and gender.
- TC was a poor indicator of underlying lipoprotein abnormalities.
- Lipoprotein profiles showed no significant changes after converting from CsA to tacrolimus.
Conclusions:
- Lipoprotein abnormalities are highly prevalent in pediatric heart transplant recipients.
- Total cholesterol is an inadequate screening tool for lipid disorders in this population.
- Conversion from CsA to tacrolimus did not alter lipid profiles.
Abstract:
The role of hyperlipidemia in graft coronary artery disease (GCAD) is controversial although hyper-triglyceridemia is an independent risk factor. Recent studies show that 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) inhibitors decrease the incidence of GCAD in adults. The incidence of GCAD in pediatric patients is lower than in adults; it is not clear whether age-related differences in lipid metabolism account for some of this protection. This study was performed to: characterize the lipoprotein profile in children after heart transplantation; demonstrate that total cholesterol (TC) is a poor marker for underlying lipoprotein abnormalities; and to compare lipid abnormalities in patients who had been converted from cyclosporin A (CsA) to tacrolimus. Seventy-one determinations of fasting lipoprotein profiles were performed in a cohort of 28 children. Each child had at least two determinations on separate occasions. TC, low-density lipoprotein (LDL), and serum triglyceride (TG) levels were categorized as abnormal if greater than the 75th percentile for age and gender. A high-density lipoprotein (HDL) level less than the 25th percentile was considered abnormal. Immunosuppression included CsA or tacrolimus, azathioprine, and prednisone. We found that 90% of the patients studied had abnormalities of either TG or HDL. In contrast, LDL tended to be normal when adjusted for age and gender. TC was a poor indicator of any underlying abnormality in TG, LDL, or HDL. In patients converted to tacrolimus, no significant differences were found in the levels of TG, LDL or HDL compared with each patient's respective values while receiving CsA. Hence, lipoprotein abnormalities among pediatric heart transplant recipients are highly prevalent. TC is a poor screening tool in the evaluation for lipid abnormalities. Lipoprotein profiles remain statistically unchanged after conversion from CsA to tacrolimus.