title: Lipid profile changes during the first year after kidney transplantation: risk factors and influence of the immunosuppressive drug regimen.
abstract: OBJECTIVE
  This study analyzed the incidence, time course, and risk factors associated with dyslipidemia during the first year after kidney transplantation among patients receiving various immunosuppressive regimens.
  
  
  METHODS
  The analysis included 474 kidney transplant recipients receiving cyclosporine (CSA) combined with sirolimus (SRL; n=137) or mycophenolate (MMF, n=58) or everolimus (EVR, n=47); or SRL combined with MMF (n=32); or tacrolimus (TAC) combined with SRL (n=86) or MMF (n=114). All patients received prednisone. We evaluated the influence of demographic features, clinical outcomes, and statin use on lipid profiles during the first year after transplantation. total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (hdl-C), low-density lipoprotein cholesterol (ldl-C), non-HDL-C, TC:HDL-C, LDL-C:HDL-C, TG:HDL-C.
  
  
  RESULTS
  Lipid profiles were within the recommended ranges in 28% of patients pretransplantation and in 10% at 1 year; 27% of them received statins. At 1 year, LDL-C<100 mg/dL was observed in 31.8% of patients but more than 35% of these patients still showed other lipid fractions or ratios outside recommended target concentrations. Among all patients with LDL-C>100 mg/dL, almost 70% to 80% had other lipid fractions or ratios within target ranges. A logistic regression analysis showed age, gender, time on dialysis, diabetes, type of calcineurin inhibitor (CSA vs TAC), adjunctive therapy (SRL/EVR vs MMF) and prednisone dose to be associated with dyslipidemia.
  
  
  CONCLUSIONS
  Dyslipidemia is frequent at 1 year after transplantation. The lack of agreement among changes observed in lipid fractions and ratios suggests that more studies are necessary to guide therapy besides targeting LDL-C concentrations as recommended by current guidelines.
authors.affiliation: Nephrology Division, Hospital do Rim e Hipertensao, Universidade Federal de Sao Paulo (UNIFESP), São Paulo, SP, Brazil. gapspinelli@nefro.epm.br
authors.forename: G A
authors.initials: GA
authors.lastname: Spinelli
authors.forename: C R
authors.initials: CR
authors.lastname: Felipe
authors.forename: S I
authors.initials: SI
authors.lastname: Park
authors.forename: E L
authors.initials: EL
authors.lastname: Mandia-Sampaio
authors.forename: H
authors.initials: H
authors.lastname: Tedesco-Silva
authors.forename: J O
authors.initials: JO
authors.lastname: Medina-Pestana
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001938:Brazil / Q000453:epidemiology; D016009:Chi-Square Distribution; D016572:Cyclosporine / Q000009:adverse effects; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008055:Lipids / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives; D016017:Odds Ratio; D011241:Prednisone / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives; D016559:Tacrolimus / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D008055:Lipids; D016572:Cyclosporine; D000068338:Everolimus; D009173:Mycophenolic Acid; D011241:Prednisone; D020123:Sirolimus; D016559:Tacrolimus