Drug-related dyslipidemia after renal transplantation

The frequency, onset, mechanisms, and causes of dyslipidemia after renal transplantation are reviewed in the context of the adverse impact of lipid alterations, recent guidelines, and the available treatment options.

At least 60% of adult renal transplant recipients develop dyslipidemia, which occurs within one month of the initiation of immunosuppressive therapy and continues indefinitely unless treated. Cyclosporine, sirolimus, and prednisone are mainly implicated, and the lipid profile differs between individual agents. In recognition that lipid alterations in these patients are linked with development of ischemic heart disease, vascular mortality, and graft deterioration, the National Kidney Foundation has recently released guidelines suggesting a low-density-lipoprotein (LDL) cholesterol goal of < 100 mg/dL for these patients. Statins and diet therapy are recommended as first-line agents for achieving goal LDL cholesterol levels in this population. Recent evidence proved a reduction in adverse cardiovascular events when fluvastatin was utilized in one large-scale trial. Care should be taken with aggressive dosage adjustment because of the potential for a pharmacokinetic interaction with cyclosporine and a resultant increase in the risk of myopathy or rhabdomyolysis. Other options for improving the lipid profile include modifications in the immunosuppressive regimen, the addition of other lipid-modifying agents, and using alternative lipid-modifying agents.

Statins and diet therapy should be used as first-line treatments in renal transplant recipients with dyslipidemia. Other strategies, including modification of the immunosuppressive regimen, and the addition of other lipid-modifying agents, have also yielded positive results.