[Dyslipidaemia and its management after immunosuppressive treatment]

This article summarises the mechanisms responsible for the hyperlipidaemia observed after immunosuppressive treatment. Much progress has been achieved in the treatment of organ transplantation over the last 10 years, in particular because of the use of new immunosuppressive drugs with less nephrotoxicity. However, hypercholesterolaemia and hypertriglyceridaemia persist among many patients, who are thus more likely to develop cardiovascular diseases. We first reviewed the effects of immunosuppressive drugs on biliary acid biosynthesis, which is the main pathway of cholesterol degradation. The inhibition of this biosynthesis pathway, and especially of some key cytochrome P450s (CYP) such as CYP27A1, could contribute to the increased cholesterolaemia. Immunosuppressive drugs may also modify the activity of lipoprotein receptors or the expression of different apolipoproteins involved in cholesterol and triglyceride transport by lipoproteins. Finally, the fact that hypertriglyceridaemia is more frequently observed after certain immunosuppressive treatments may be partly caused by changes in the synthesis and elimination of triglycerides involving lipoprotein lipase or some apolipoproteins which serve as its cofactors (apoCII or apoCIII).