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Decrease in lipoprotein(a) after renal transplantation is related to the glucocorticoid dose

N von Ahsen1, M Helmhold, T Eisenhauer

  • 1Abteilung Klinische Chemie, Georg-August-Universität, Göttingen, Germany.

European Journal of Clinical Investigation
|August 1, 1996
PubMed
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Serum lipoprotein(a) [Lp(a)] levels significantly decreased after kidney transplantation, particularly with high-dose corticosteroids. Levels rose as steroid doses decreased but remained lower in women long-term.

Area of Science:

  • Nephrology
  • Cardiovascular Science
  • Clinical Biochemistry

Background:

  • End-stage renal disease (ESRD) is associated with cardiovascular risk factors, including elevated lipoprotein(a) [Lp(a)].
  • Lp(a) is an independent risk factor for atherosclerosis and cardiovascular disease.
  • The impact of renal transplantation and immunosuppressive therapy on Lp(a) levels in ESRD patients is not fully understood.

Purpose of the Study:

  • To investigate the changes in serum Lp(a) concentrations and apolipoprotein(a) [apo(a)] phenotypes in patients with ESRD following renal transplantation.
  • To assess the influence of immunosuppressive therapy, including cyclosporin A, prednisone, and azathioprine, on Lp(a) levels post-transplantation.

Main Methods:

  • Serum Lp(a) levels and apo(a) phenotypes were measured in 46 ESRD patients before and at several time points after renal transplantation (1 week, 1, 3, and 6 months).

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  • Patients received immunosuppressive therapy consisting of cyclosporin A, prednisone, and azathioprine.
  • Lp(a) levels were compared to a healthy control group and analyzed in relation to medication doses and patient sex.

    • Main Results:

    • Pre-transplantation Lp(a) levels were comparable between ESRD patients and healthy controls.
    • A significant reduction in Lp(a) levels (P < 0.001) was observed one week post-transplantation, coinciding with high-dose corticosteroid use.
    • Lp(a) levels increased as steroid doses were tapered, but remained significantly reduced (P < 0.01) in women at 6 months.
    • No significant correlation was found between Lp(a) levels and cyclosporin or azathioprine dosages.
    • The Lp(a) reduction was consistent across all observed apo(a) phenotypes.

    Conclusions:

    • Renal transplantation, particularly the initial high-dose corticosteroid therapy, leads to a significant decrease in serum Lp(a) levels in ESRD patients.
    • While Lp(a) levels tend to rise with steroid tapering, they may remain suppressed long-term, especially in female recipients.
    • These findings suggest a potential cardiovascular benefit of renal transplantation beyond improved renal function, mediated partly by Lp(a) modulation.