Hypercholesterolemia is common after pediatric heart transplantation: initial experience with pravastatin.
BACKGROUND
Coronary allograft vasculopathy (CAV) is a progressive complication after cardiac transplantation and limits survival. Hyperlipidemia is a known risk factor for CAV, and pravastatin is effective in decreasing cholesterol levels in adults after transplantation. However, few data exist regarding lipid profiles and statin use after pediatric heart transplantation. We evaluated the prevalence of hyperlipidemia in pediatric heart transplant recipients and assessed the efficacy and safety of pravastatin therapy.


METHODS
We performed a retrospective chart review of lipid profiles > or =1 year after surgery in 50 pediatric cardiac transplant recipients to assess the incidence of hyperlipidemia. Twenty of these patients received pravastatin for hypercholesterolemia. Their primary immunosuppression therapy was cyclosporine/prednisone plus either azathioprine or mycophenolate mofetil. We reviewed serial lipid profiles, creatinine phosphokinase, and liver enzymes.


RESULTS
Overall, 36% of the patients (n = 50) had total cholesterol (TC) concentrations > 200 mg/dl and 52% had low-density lipoprotein (LDL) >110 mg/dL beyond 1 year after transplantation. Of the 20 treated with pravastatin, TC (236 +/- 51 vs 174 +/- 33 mg/dl) and LDL levels (151 +/- 32 vs 99 +/- 21 mg/dl) decreased significantly with therapy (p <.0001). We found no symptoms; however, 1 patient had increased creatinine phosphokinase. Liver enzyme concentrations remained normal in all.


CONCLUSIONS
Hypercholesterolemia is prevalent in pediatric cardiac transplant recipients. Pravastatin therapy is effective in decreasing TC and LDL levels, seems to be safe, and is tolerated well. Further studies are necessary to determine whether pravastatin treatment is beneficial in decreasing CAV.
Seipelt
Ingrid M
IM
Department of Pathology, Children's Memorial Hospital, Northwestern Medical School, Chicago, Illinois 60614, USA.
Crawford
Susan E
SE
Rodgers
Sherrie
S
Backer
Carl
C
Mavroudis
Constantine
C
Seipelt
Ralf G
RG
Pahl
Elfriede
E
D000328:Adult; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002648:Child; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003327:Coronary Disease / Q000517:prevention & control*; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy* / Q000453:epidemiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D017035:Pravastatin / Q000627:therapeutic use*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
D000924:Anticholesteremic Agents; D007166:Immunosuppressive Agents; D014280:Triglycerides; D002784:Cholesterol; D017035:Pravastatin