Tacrolimus as intervention in the treatment of hyperlipidemia after liver transplant.
BACKGROUND
To measure the effect on serum lipids and other risk factors for cardiovascular disease, we converted the primary immunosuppression of dyslipidemic stable liver transplant recipients from cyclosporine A to tacrolimus.


METHODS
Patients underwent a four-month dietary stabilization period (American Heart Association Step II diet) and serum lipid samples were collected for analysis at a central laboratory. After conversion, dietary counseling and lipid analyses were performed over a six-month postconversion observation period.


RESULTS
Enrollment was terminated prematurely due to low patient recruitment rates. Thirteen patients were enrolled and provided postconversion data showing surprisingly strong results. At six months postconversion, total cholesterol (C) was reduced by a mean of 0.61 mmol/L (P=0.017), high density lipoprotein cholesterol (HDL-C) remained unchanged; the mean total C:HDL-C ratio was reduced by 0.87 (P=0.001). Low density lipoprotein cholesterol (LDL-C) reductions were not statistically significant, but we observed a significant and persistent decrease in apolipoprotein B (-0.15 g/L six months postconversion, P=0.031). No changes in homocysteine or in vitamins B6 and B12 were discerned, but although red cell folate remained stable, serum folate increased after conversion. We observed no rejection episodes or any other clinically notable events following conversion.


CONCLUSIONS
In this study, conversion from cyclosporine to tacrolimus provided a safe and well-tolerated alternative that reduced hyperlipidemia and other recognized cardiovascular risk factors.
Roy
André
A
University of Montreal, CHUM-Hopital St-Luc, Montreal, Quebec, Canada. andre.roy.chum@ssss.gouv.qc.ca
Kneteman
Norman
N
Lilly
Leslie
L
Marotta
Paul
P
Peltekian
Kevork
K
Scudamore
Charles
C
Tchervenkov
Jean
J
D000328:Adult; D000368:Aged; D005260:Female; D006084:Graft Rejection; D006710:Homocysteine / Q000097:blood; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents; D008055:Lipids; D006710:Homocysteine; D016559:Tacrolimus