Related Experiment Videos
Hypercholesterolemia after heart transplantation: amelioration by corticosteroid-free maintenance immunosuppression
D G Renlund1, M R Bristow, B G Crandall
1Division of Cardiology, University of Utah Medical Center, Salt Lake City 84132.
Insights
Corticosteroids significantly increase high cholesterol (hypercholesterolemia) in heart transplant patients. Avoiding these drugs lowers cholesterol levels post-transplant, suggesting a key role for corticosteroids in this common complication.
Area of Science:
- Cardiology
- Transplantation Medicine
- Pharmacology
Background:
- Hypercholesterolemia is a frequent complication in heart transplant recipients.
- The underlying causes of post-transplant hypercholesterolemia are not fully understood.
Purpose of the Study:
- To investigate the role of corticosteroids in the development of hypercholesterolemia after heart transplantation.
- To test the hypothesis that corticosteroid use contributes to elevated cholesterol levels.
Main Methods:
- A retrospective review of 117 heart transplant recipients surviving over 4 months.
- Comparison of serum cholesterol levels between patients requiring maintenance corticosteroids and those not requiring them.
- Analysis of serum cyclosporine levels to rule out its contribution.
Main Results:
- Patients not requiring corticosteroids had 21% to 26% lower cholesterol levels during the first 18 months post-transplant (p < 0.001).
- Average cholesterol levels were significantly lower in the corticosteroid-free group (199-211 mg/dl) compared to the corticosteroid group (262-272 mg/dl).
- Serum cyclosporine levels did not differ between the groups, indicating it was not a primary factor.
Conclusions:
- Corticosteroid administration is a significant contributor to hypercholesterolemia following heart transplantation.
- While multifactorial, managing corticosteroid use may help mitigate post-transplant hypercholesterolemia.
Abstract:
Most heart transplant recipients develop hypercholesterolemia, the cause of which is poorly understood. To test the hypothesis that corticosteroids contribute to the hypercholesterolemia, we reviewed 117 consecutive heart transplant recipients who survived more than 4 months, of whom 51 (44%) required and 66 (56%) did not require maintenance corticosteroids, chronic immunosuppression maintained with cyclosporine and azathioprine only. Fasting serum cholesterol levels were measured every 3 months and were found to be 21% to 26% lower during the first 18 months after heart transplantation in the group that did not require chronic corticosteroid administration (p less than 0.001). Beginning 3 months after transplantation, average serum cholesterol levels ranged from 199 +/- 8 mg/dl to 211 +/- 9 mg/dl in the corticosteroid-free group compared with 262 +/- 8 mg/dl to 272 +/- 8 mg/dl in patients requiring corticosteroid maintenance immunosuppression. Because serum cyclosporine levels did not differ between the groups, a contribution by cyclosporine to posttransplant hypercholesterolemia could not be substantiated. Although the hypercholesterolemia that occurs after heart transplantation is undoubtedly multifactorial, corticosteroid administration contributes importantly to its development.