title: Obesity and hyperhomocysteinaemia after kidney transplantation.
abstract: Obesity and hyperhomocysteinaemia are found very frequently after kidney transplantation (Tx). They may independently represent risk factors for development of atherosclerosis and chronic allograft nephropathy. In a prospective metabolic study, we monitored, over a period of 24 months, a total of 118 obese transplant patients [body mass index (BMI) > or =30 kg/m(2)] with hyperhomocysteinaemia. We compared the findings of a new therapeutic regimen at 1 year (start of the study) and 2 years after renal transplantation. Based on a Subjective Global Assessment Scoring Sheet, we started at the end of the first year with an individualized hypoenergic-hypolipidaemic diet (IHHD). Subsequently, after corticoid withdrawal, IHHD was supplemented regularly with orlistat at a dose of up to 3 x 120 mg/day, statins (pravastatin 10-40 mg), folic acid 5 mg/day and vitamin B6 50 mg/day, and followed-up for up to 2 years. All patients were on a regimen of cyclosporin A and mycophenolate mofetil. During the study period, there was a significant decrease in BMI (P < 0.025) and total homocysteine level (P < 0.001). Long-term therapy was associated with a significant decrease in serum leptin (P < 0.001) and lipid metabolism parameters (P < 0.01). The mean values of serum folate and vitamin B6 also increased significantly (P < 0.01); creatinine clearance, mean blood pressure, proteinuria, lipoprotein(a) and apolipoprotein E isoforms did not differ significantly. Based on our results, we assume that obesity and hyperhomocysteinaemia after renal transplantation can be treated effectively by modified immunosuppression (corticosteroid withdrawal), long-term diet (IHHD), folic acid and vitamin B6 supplementation, and drugs suppressing digestion or absorption to reduce atherosclerotic and chronic allograft nephrop-athy processes.
authors.affiliation: Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine, Chair of Nephrology, Institute for Postgraduate Medical Education, Prague, Czech Republic. vladimir.teplan@medicon.cz
authors.forename: Vladimír
authors.initials: V
authors.lastname: Teplan
authors.forename: Otto
authors.initials: O
authors.lastname: Schück
authors.forename: Milena
authors.initials: M
authors.lastname: Stollová
authors.forename: Stefan
authors.initials: S
authors.lastname: Vítko
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004035:Diet Therapy / Q000379:methods*; D004359:Drug Therapy, Combination; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D020138:Hyperhomocysteinemia / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D011183:Postoperative Complications; D017035:Pravastatin / Q000008:administration & dosage; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D025101:Vitamin B 6 / Q000008:administration & dosage
chemical_list: D007166:Immunosuppressive Agents; D025101:Vitamin B 6; D005492:Folic Acid; D017035:Pravastatin