Immunosuppressive Agents and Metabolic Factors of Cardiovascular Risk in Renal Transplant Recipients

• Published in: Transplantation proceedings Vol. 41; no. 4; pp. 1178 - 1182
• Main Authors: Sessa, A, Esposito, A, Giliberti, A, Iavicoli, G, Costa, C, Bergallo, M, Lettieri, E, Rossano, R, Capuano, M
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01-05-2009; Elsevier
• Subjects: Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Calcineurin Inhibitors; Cardiology. Vascular system; Cardiovascular Diseases - blood; Cardiovascular Diseases - epidemiology; Cyclosporine - therapeutic use; Drug Therapy, Combination; Everolimus; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Glomerular Filtration Rate; Humans; Hyperhomocysteinemia - prevention & control; Hyperlipidemias - prevention & control; Hyperuricemia - prevention & control; Immunosuppressive Agents - therapeutic use; Kidney Transplantation; Lipoproteins, HDL; Medical sciences; Middle Aged; Risk Factors; Sirolimus - analogs & derivatives; Sirolimus - therapeutic use; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tacrolimus - therapeutic use; Tissue, organ and graft immunology; Transplant Recipients; Cardiovascular disease; Transplantation; Homotransplantation; Metabolism; Kidney; Vascular disease; Medicine; Treatment; Urinary system; Surgery; Atherosclerosis; Risk factor; Cardiovascular risk; Graft; Immunosuppressive agent; Pharmacokinetics
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2009.02.045

Abstract Cardiovascular disease (CVD) accounts for 35% to 50% of deaths among renal transplant recipients. Beside the atherogenic risk factors related to hemodialysis, renal function, and use of immunosuppressive agents, other relevant risk factors for CVD include acute rejection episodes, microalbuminuria (μAlb), diabetes, arterial hypertension, lipid disorders, inflammatory triggers, hyperhomocysteinemia, anemia, erythrocytosis, obesity, and hyperuricemia. We studied the prevalence of risk factors and the impact of various drugs on CVD among 103 renal transplant recipients with measured glomerular filtration rates showing values >45 mL/min. We measured uric acid, triglycerides (TG), low-density lipoprotein (LDL)/high-density lipoprotein (HDL) LDL/HDL ratio, homocysteine (HOMO), insulin resistance, μAlb, C-reactive protein (CRP), and fibrinogen. Subsequently, patients were divided into 8 groups based on the immunosuppressive protocol to evaluate its impact on CVD risk factors. Insulin resistance and hyperhomocysteinemia were present in >2/3 of patients. Considering the impact of protocols, the combination of cyclosporine (CsA) + everolimus (EVL) resulted in the most favorable profile in terms of reduction of hyperuricemia, hyperlipidemia, and hyperhomocysteinemia. Insulin resistance tended to be more frequent among patients treated with protocols including calcineurin inhibitors (CNI) and steroids. The prevalence of hyperhomocyteinemia was similar among patients on CsA and on tacrolimus (Tac). Sirolimus (SRL) was associated with higher levels of HOMO. The combination of CNI and proliferative signal inhibitors (PSI) seemed to be the most promising one to reduce the impact of CVD risk factors. The reduction in CVD morbidity can improve expectancy and quality of life, as well as graft function and survival among renal transplant patients.