title: Determinants of fasting total serum homocysteine levels in liver transplant recipients.
abstract: OBJECTIVE
  Homocysteine (HCY) is a sulfur-containing amino acid considered to be a marker for a relative folate deficiency. Hyperhomocysteinemia is a known risk factor for development of cardiovascular disease, vascular dementia, depression, and possibly some carcinogeneses. Liver transplant recipients have an increased risk for cardiovascular disease because of a high incidence of obesity, arterial hypertension, diabetes mellitus, and hyperlipidemia. The aim of this study is to elucidate the determinants for hyperhomocysteinemia as an additional risk factor in these patients.
  
  
  METHODS
  Seventy stable liver transplant recipients, 48 men (mean age, 50+/-11 years) and 22 women (mean age, 52+/-13 years) had their serum homocysteine levels tested after orthotopic liver transplantation. For mainstay immunosuppression, 53 patients were treated with tacrolimus, 10 with cyclosporine, 3 with mycophenolate mofetil, and 4 with sirolimus. Fasting blood samples were obtained and analyzed immediately (within 1 hour) for total serum homocysteine by high-performance liquid chromatography.
  
  
  RESULTS
  In all patients, mean homocysteine levels were 22.7+/-14 micromol/L (normal range, 9-15 micromol/L). Forty-six patients were found to have homocysteine levels>15 micromol/L, and all 70 recipients had homocysteine levels>9 micromol/mL. In our patients, increased homocysteine levels correlated well with body mass index and renal function. Homocysteine levels in patients receiving cyclosporine were higher than those in patients receiving tacrolimus (22.3+/-6 vs 17.9+/-12 micromol/L, P<.05).
  
  
  CONCLUSIONS
  Overall, homocysteine levels are significantly increased in liver transplant recipients. Homocysteine levels correlate well with obesity, renal function, and the particular immunosuppressant protocol. Therefore, a specific treatment for patients after liver transplantation (eg, one with folates) might reduce the risk of complications resulting from hyperhomocysteinemia.
authors.affiliation: First Department of Internal Medicine and Gastroenterology, Johann Wolfgang Goethe- University, Theodor Stern Kai 7, D-60596 Frankfurt, Germany.
authors.forename: Bora
authors.initials: B
authors.lastname: Akoglu
authors.forename: Kathrin
authors.initials: K
authors.lastname: Wondra
authors.forename: Wolfgang F
authors.initials: WF
authors.lastname: Caspary
authors.forename: Dominik
authors.initials: D
authors.lastname: Faust
mesh_terms: D000328:Adult; D000368:Aged; D005215:Fasting / Q000097:blood*; D005260:Female; D005492:Folic Acid / Q000378:metabolism; D005494:Folic Acid Deficiency / Q000097:blood / Q000150:complications / Q000209:etiology; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000150:complications / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D006710:Homocysteine; D005492:Folic Acid